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Thromb Haemost 2024; 124(09): 861-869
DOI: 10.1055/s-0044-1785519
Stroke, Systemic or Venous Thromboembolism

In-Hospital Pulmonary Arterial Embolism after Catheter Ablation of Over 45,000 Cardiac Arrhythmias: Individualized Case Analysis of Multicentric Data

Florian Doldi 
1   Department for Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
,
Nele Geßler
2   Department of Cardiology and Intensive Care, Asklepios Clinic St. Georg, Hamburg, Germany
,
Omar Anwar
2   Department of Cardiology and Intensive Care, Asklepios Clinic St. Georg, Hamburg, Germany
,
Ann-Kathrin Kahle 
3   Klinik für Kardiologie, Angiologie, Intensivmedizin, cNEP Research Consortium EVK, Düsseldorf, Germany
,
Katharina Scherschel
3   Klinik für Kardiologie, Angiologie, Intensivmedizin, cNEP Research Consortium EVK, Düsseldorf, Germany
,
Benjamin Rath
1   Department for Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
,
Julia Köbe
1   Department for Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
,
Philipp Sebastian Lange
1   Department for Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
,
Gerrit Frommeyer
1   Department for Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
,
Andreas Metzner
4   Klinik und Poliklinik für Kardiologie, Universitäres Herz- und Gefäßzentrum UKE Hamburg, Hamburg, Germany
,
Christian Meyer
3   Klinik für Kardiologie, Angiologie, Intensivmedizin, cNEP Research Consortium EVK, Düsseldorf, Germany
,
Stephan Willems
2   Department of Cardiology and Intensive Care, Asklepios Clinic St. Georg, Hamburg, Germany
,
Karl-Heinz Kuck
2   Department of Cardiology and Intensive Care, Asklepios Clinic St. Georg, Hamburg, Germany
,
Lars Eckardt
1   Department for Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
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Comment on:

Pulmonary Thromboembolism after Catheter Ablation of Cardiac ArrhythmiasThromb Haemost 2024; 124(09): 870-873
DOI: 10.1055/a-2366-7245

Abstract

Objective and Background Data on incidence of in-hospital pulmonary embolisms (PE) after catheter ablation (CA) are scarce. To gain further insights, we sought to provide new findings through case-based analyses of administrative data.

Methods Incidences of PE after CA of supraventricular tachycardias (SVT), atrial fibrillation (AF), atrial flutter (AFlu), and ventricular tachycardias (VT) in three German tertiary centers between 2005 and 2020 were determined and coded by the G-DRG (German Diagnosis Related Groups System) and OPS (German Operation and Procedure Classification) systems. An administrative search was performed with a consecutive case-based analysis.

Results Overall, 47,344 ablations were analyzed (10,037 SVT; 28,048 AF; 6,252 AFlu; 3,007 VT). PE occurred in 14 (0.03%) predominantly female (n = 9; 64.3%) patients with a mean age of 55.3 ± 16.9 years, body mass index 26.2 ± 5.1 kg/m2, and left ventricular ejection fraction of 56 ± 13.6%. PE incidences were 0.05% (n = 5) for SVT, 0.02% (n = 5) for AF, and 0.13% (n = 4) for VT ablations. No patient suffered PE after AFlu ablation. Five patients (35.7%) with PE after CA had no prior indication for oral anticoagulation (OAC). Preprocedural international normalized ratio in PE patients was 1.2 ± 0.5. Most patients with PE following CA presented with symptoms the day after the procedure (n = 9) after intraprocedural heparin application of 12,943.2 ± 5,415.5 IU. PE treatment included anticoagulation with either phenprocoumon (n = 5) or non-vitamin K-dependent OAC (n = 9). Two patients with PE died after VT/AF ablation, respectively. The remaining patients were discharged without sequels.

Conclusion Over a 15-year period, incidence of PE after ablation is low, particularly low in patients with ablation for AF/AFlu. This is most likely due to stricter anticoagulation management in these patients compared with those receiving SVT/VT ablation procedures and could argue for continuation of OAC prior to ablation. Optimizing periprocedural anticoagulation management should be subject of further prospective trials.

Keywords

complications - pulmonary arterial embolism - ablation - arrhythmias


Publication History

Received: 17 November 2023

Accepted: 05 March 2024

Article published online:
31 March 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Brugada J, Katritsis DG, Arbelo E. et al; ESC Scientific Document Group. 2019 ESC Guidelines for the management of patients with supraventricular tachycardia: the Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC). Eur Heart J 2020; 41 (05) 655-720
    CrossrefPubMedSearch in Google Scholar
  • 2 Doldi F, Gessler N, Anwar O. et al. In-hospital mortality and major complications related to radiofrequency catheter ablations of over 10 000 supraventricular arrhythmias from 2005 to 2020: individualized case analysis of multicentric administrative data. Europace 2023; 25 (01) 130-136
    CrossrefPubMedSearch in Google Scholar
  • 3 Könemann H, Ellermann C, Zeppenfeld K, Eckardt L. Management of ventricular arrhythmias worldwide: comparison of the latest ESC, AHA/ACC/HRS, and CCS/CHRS guidelines. JACC Clin Electrophysiol 2023; 9 (05) 715-728
    PubMedSearch in Google Scholar
  • 4 Könemann H, Dagres N, Merino JL. et al. Spotlight on the 2022 ESC guideline management of ventricular arrhythmias and prevention of sudden cardiac death: 10 novel key aspects. Europace 2023; 25 (05) euad091
    CrossrefPubMedSearch in Google Scholar
  • 5 Ribbing M, Wasmer K, Mönnig G. et al. Endocardial mapping of right ventricular outflow tract tachycardia using noncontact activation mapping. J Cardiovasc Electrophysiol 2003; 14 (06) 602-608
    CrossrefPubMedSearch in Google Scholar
  • 6 Schnabel RB, Marinelli EA, Arbelo E. et al. Early diagnosis and better rhythm management to improve outcomes in patients with atrial fibrillation: the 8th AFNET/EHRA consensus conference. EP Europace 2023; 25: 6-27
    CrossrefPubMedSearch in Google Scholar
  • 7 Brachmann J, Lewalter T, Kuck KH. et al. Long-term symptom improvement and patient satisfaction following catheter ablation of supraventricular tachycardia: insights from the German ablation registry. Eur Heart J 2017; 38 (17) 1317-1326
    CrossrefPubMedSearch in Google Scholar
  • 8 Johner N, Namdar M, Shah DC. Safety, efficacy and prognostic benefit of atrial fibrillation ablation in heart failure with preserved ejection fraction. Arrhythm Electrophysiol Rev 2022; 11: e18
    CrossrefPubMedSearch in Google Scholar
  • 9 Marrouche NF, Brachmann J, Andresen D. et al; CASTLE-AF Investigators. Catheter ablation for atrial fibrillation with heart failure. N Engl J Med 2018; 378 (05) 417-427
    CrossrefPubMedSearch in Google Scholar
  • 10 Kirchhof P, Camm AJ, Goette A. et al; EAST-AFNET 4 Trial Investigators. Early rhythm-control therapy in patients with atrial fibrillation. N Engl J Med 2020; 383 (14) 1305-1316
    CrossrefPubMedSearch in Google Scholar
  • 11 Willems S, Meyer C, de Bono J. et al. Cabins, castles, and constant hearts: rhythm control therapy in patients with atrial fibrillation. Eur Heart J 2019; 40 (46) 3793-3799
    CrossrefPubMedSearch in Google Scholar
  • 12 Eckardt L, Sehner S, Suling A. et al. Attaining sinus rhythm mediates improved outcome with early rhythm control therapy of atrial fibrillation: the EAST-AFNET 4 trial. Eur Heart J 2022; 43 (40) 4127-4144
    CrossrefPubMedSearch in Google Scholar
  • 13 Eckardt L, Wolfes J, Frommeyer G. Benefits of early rhythm control of atrial fibrillation. Trends Cardiovasc Med 2023; (e-pub ahead of print).
    CrossrefPubMedSearch in Google Scholar
  • 14 Della Bella P, Baratto F, Vergara P. et al. Does timing of ventricular tachycardia ablation affect prognosis in patients with an implantable cardioverter defibrillator? Results from the multicenter randomized PARTITA trial. Circulation 2022; 145 (25) 1829-1838
    CrossrefPubMedSearch in Google Scholar
  • 15 Atti V, Vuddanda V, Turagam MK. et al. Prophylactic catheter ablation of ventricular tachycardia in ischemic cardiomyopathy: a systematic review and meta-analysis of randomized controlled trials. J Interv Card Electrophysiol 2018; 53 (02) 207-215
    CrossrefPubMedSearch in Google Scholar
  • 16 Könemann H, Güler-Eren S, Ellermann C, Frommeyer G, Eckardt L. Antiarrhythmic treatment in heart failure. Curr Heart Fail Rep 2024; 21 (01) 22-32
    CrossrefPubMedSearch in Google Scholar
  • 17 Eckardt L, Doldi F, Busch S. et al. 10-year follow-up of interventional electrophysiology: updated German survey during the COVID-19 pandemic. Clin Res Cardiol 2023; 112 (06) 784-794
    CrossrefPubMedSearch in Google Scholar
  • 18 Nielsen JC, Lin YJ, de Oliveira Figueiredo MJ. et al; ESC Scientific Document Group. European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on risk assessment in cardiac arrhythmias: use the right tool for the right outcome, in the right population. Europace 2020; 22 (08) 1147-1148
    CrossrefPubMedSearch in Google Scholar
  • 19 Haman L, Parízek P, Malý R, Duda J, Malý J. Analysis of thrombotic complications after catheter ablation. Acta Med (Hradec Kralove) 2006; 49 (01) 47-50
    CrossrefPubMedSearch in Google Scholar
  • 20 O'Hara GE, Philippon F, Champagne J. et al. Catheter ablation for cardiac arrhythmias: a 14-year experience with 5330 consecutive patients at the Quebec Heart Institute, Laval Hospital. Can J Cardiol 2007; 23 (Suppl B, Suppl B): 67B-70B
    CrossrefPubMedSearch in Google Scholar
  • 21 Guler GB, Can MM, Guler E. et al. Asymptomatic pulmonary embolism after ablation. Cardiology 2016; 134 (04) 426-432
    CrossrefPubMedSearch in Google Scholar
  • 22 Burstein B, Barbosa RS, Kalfon E, Joza J, Bernier M, Essebag V. Venous thrombosis after electrophysiology procedures: a systematic review. Chest 2017; 152 (03) 574-586
    CrossrefPubMedSearch in Google Scholar
  • 23 Eckardt L, Doldi F, Anwar O. et al. Major in-hospital complications after catheter ablation of cardiac arrhythmias: individual case analysis of 43 031 procedures. Europace 2023; 26 (01) euad361
    CrossrefPubMedSearch in Google Scholar
  • 24 Hosseini SM, Rozen G, Saleh A. et al. Catheter ablation for cardiac arrhythmias: utilization and in-hospital complications, 2000 to 2013. JACC Clin Electrophysiol 2017; 3 (11) 1240-1248
    CrossrefPubMedSearch in Google Scholar
  • 25 Bohnen M, Stevenson WG, Tedrow UB. et al. Incidence and predictors of major complications from contemporary catheter ablation to treat cardiac arrhythmias. Heart Rhythm 2011; 8 (11) 1661-1666
    CrossrefPubMedSearch in Google Scholar
  • 26 Gupta A, Perera T, Ganesan A. et al. Complications of catheter ablation of atrial fibrillation: a systematic review. Circ Arrhythm Electrophysiol 2013; 6 (06) 1082-1088
    CrossrefPubMedSearch in Google Scholar
  • 27 Dechering DG, Gonska BD, Brachmann J. et al. Efficacy and complications of cavo-tricuspid isthmus-dependent atrial flutter ablation in patients with and without structural heart disease: results from the German Ablation Registry. J Interv Card Electrophysiol 2021; 61 (01) 55-62
    CrossrefPubMedSearch in Google Scholar
  • 28 König S, Ueberham L, Müller-Röthing R. et al. Catheter ablation of ventricular arrhythmias and in-hospital mortality: insights from the German-wide Helios hospital network of 5052 cases. Europace 2020; 22 (01) 100-108
    PubMedSearch in Google Scholar
  • 29 Mathew S, Fink T, Feickert S. et al. Complications and mortality after catheter ablation of ventricular arrhythmias: risk in VT ablation (RIVA) score. Clin Res Cardiol 2022; 111 (05) 530-540
    CrossrefPubMedSearch in Google Scholar
  • 30 Peichl P, Wichterle D, Pavlu L, Cihak R, Aldhoon B, Kautzner J. Complications of catheter ablation of ventricular tachycardia: a single-center experience. Circ Arrhythm Electrophysiol 2014; 7 (04) 684-690
    CrossrefPubMedSearch in Google Scholar
  • 31 Doldi F, Doldi PM, Plagwitz L. et al. Predictors for major in-hospital complications after catheter ablation of ventricular arrhythmias: validation and modification of the Risk in Ventricular Ablation (RIVA) Score. Clin Res Cardiol 2023; 112 (12) 1778-1789
    CrossrefPubMedSearch in Google Scholar
  • 32 König S, Ueberham L, Schuler E. et al. In-hospital mortality of patients with atrial arrhythmias: insights from the German-wide Helios hospital network of 161 502 patients and 34 025 arrhythmia-related procedures. Eur Heart J 2018; 39 (44) 3947-3957
    CrossrefPubMedSearch in Google Scholar
  • 33 Burstein B, Barbosa RS, Samuel M. et al. Prevention of venous thrombosis after electrophysiology procedures: a survey of national practice. J Interv Card Electrophysiol 2018; 53 (03) 357-363
    CrossrefPubMedSearch in Google Scholar
  • 34 Packer DL, Mark DB, Robb RA. et al; CABANA Investigators. Effect of catheter ablation vs antiarrhythmic drug therapy on mortality, stroke, bleeding, and cardiac arrest among patients with atrial fibrillation: the cabana randomized clinical trial. JAMA 2019; 321 (13) 1261-1274
    CrossrefPubMedSearch in Google Scholar
  • 35 Reddy VY, Reynolds MR, Neuzil P. et al. Prophylactic catheter ablation for the prevention of defibrillator therapy. N Engl J Med 2007; 357 (26) 2657-2665
    CrossrefPubMedSearch in Google Scholar
  • 36 Steinbeck G, Sinner MF, Lutz M, Müller-Nurasyid M, Kääb S, Reinecke H. Incidence of complications related to catheter ablation of atrial fibrillation and atrial flutter: a nationwide in-hospital analysis of administrative data for Germany in 2014. Eur Heart J 2018; 39 (45) 4020-4029
    CrossrefPubMedSearch in Google Scholar
  • 37 Iliodromitis K, Lenarczyk R, Scherr D. et al. Patient selection, peri-procedural management, and ablation techniques for catheter ablation of atrial fibrillation: an EHRA survey. Europace 2023; 25 (02) 667-675
    CrossrefPubMedSearch in Google Scholar
  • 38 Calkins H, Hindricks G, Cappato R. et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: executive summary. Europace 2018; 20 (01) 157-208
    CrossrefPubMedSearch in Google Scholar
  • 39 Van Vugt SPG, Westra SW, Volleberg RHJA. et al. Meta-analysis of controlled studies on minimally interrupted vs. continuous use of non-vitamin K antagonist oral anticoagulants in catheter ablation for atrial fibrillation. Europace 2021; 23 (12) 1961-1969
    CrossrefPubMedSearch in Google Scholar
  • 40 Kirchhof P, Benussi S, Kotecha D. et al. 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace 2016; 18 (11) 1609-1678
    CrossrefPubMedSearch in Google Scholar
  • 41 Sticherling C, Marin F, Birnie D. et al. Antithrombotic management in patients undergoing electrophysiological procedures: a European Heart Rhythm Association (EHRA) position document endorsed by the ESC Working Group Thrombosis, Heart Rhythm Society (HRS), and Asia Pacific Heart Rhythm Society (APHRS). Europace 2015; 17 (08) 1197-1214
    CrossrefPubMedSearch in Google Scholar
  • 42 Wasmer K, Eckardt L, Breithardt G. Predisposing factors for atrial fibrillation in the elderly. J Geriatr Cardiol 2017; 14 (03) 179-184
    PubMedSearch in Google Scholar
  • 43 Zylla MM, Brachmann J, Lewalter T. et al. Sex-related outcome of atrial fibrillation ablation: Insights from the German Ablation Registry. Heart Rhythm 2016; 13 (09) 1837-1844
    CrossrefPubMedSearch in Google Scholar