Fehmi Keçe

Advances in Atrial Fibrillation Ablation Devices 31 2 2.2.3 Complications The use of image integration and electro-anatomical mapping has been associated with fewer complications (20-24, 35, 36). Whether CF-guided ablation improves safety requires additional investigation. In a recent meta-analysis, the overall complication and tamponade rates were 3.8% and 0.5% for CF and 3.9% and 0.9% for non-CF ablation (28). Irrigated catheters (Thermocool™, Biosense and Coolpath™, Abbot) have been introduced to prevent endothelial charring in particular at sites with low blood flow (19). Indeed, with irrigation, less micro-embolic signals have been detected with trans-cranial Doppler (37). Advanced irrigation technology (Thermocool Surround Flow and Abbot FlexAbility) reduces irrigation volume with maintenance of the safety profile (38). Thromboembolic event rates (stroke and transient ischemic attack) range between 0.2 and 1% for irrigated catheters. Phrenic nerve palsy (PNP) is rare (0.01-0.6%) and mainly transient. Similar, the reported incidence of oesophageal and vagal injury is low, ranging between 0.05-0.5% (table 1). However, a study focussing specifically on gastrointestinal complications reported an 11% incidence of thermal oesophageal lesions and a 17% incidence of gastroparesis (39). In the Manufacturer and User Facility Device Experience database of 2689 ablations the incidence of atrial-oesophageal fistula as a percentage of all reported complications for CF-catheters was higher (5.4% (65 of 1202 cases) compared to non-CF catheters (0.9% (13 of 1487 cases)(40). These numbers do not reflect the absolute incidence however. Pulmonary vein stenosis (PVS) after CF-guided ablation was only reported in one study with an incidence of 0.7% (41).