Influence of substrate modification in catheter ablation of atrial fibrillation on the incidence of acute complications: Analysis of 10 795 procedures in J‐CARAF Study 2011‐2016

• Main Authors: Yuji Murakawa, Teiichi Yamane, Masahiko Goya, Koichi Inoue, Shigeto Naito, Koichiro Kumagai, Yasushi Miyauchi, Norishige Morita, Akihiko Nogami, Morio Shoda, Ken Okumura, Kenzo Hirao, on behalf of the Japanese Heart Rhythm Society Members
• Format: Article
• Language: English
• Published: Wiley 2018-08-01
• Series: Journal of Arrhythmia
• Subjects: atrial fibrillation; catheter ablation; complex fractionated atrial electrogram; complication
• Online Access: https://doi.org/10.1002/joa3.12081
• ISSN: 1880-4276; 1883-2148

Abstract Background and purpose In expectation of better outcome of catheter ablation of atrial fibrillation (AF), several strategies of extra‐PV (pulmonary vein) substrate modification have been utilized. We assessed whether substrate modification or ablation of extra‐PV source is a predictor of complications. Methods Japanese Heart Rhythm Society requested electrophysiology centers to register the data of patients who underwent AF ablation. Results The data of 10 795 AF ablation cases (age; 63.8 ± 10.6 years) treated during 2011‐2016 were registered. Pericardial effusion (n = 105), massive bleeding (n = 108), stroke (n = 6), atrial‐esophageal fistula (n = 2), and other 114 complications occurred in 323 patients (3.0%). Univariate analysis revealed that age ≧ 65 years, female gender, heart failure, CHA2DS2‐VASc≧3, hemodialysis, deep sedation, and complex fractionated atrial electrogram (CFAE)‐guided ablation ([+] vs [−] = 4.3% vs 2.8%, P = .005) were related with the higher incidence of complications. Redo session, 3‐D imaging system ([+] vs [−]: 4.4% vs 2.9%, P = .017), and periprocedural dabigatran were related with the lower incidence of complications. None of the linear ablation of the left atrium, ganglionated plexi ablation, and superior vena cava ablation affected the incidence of complications. Multiple logistic regression analysis showed that in addition to 3‐D imaging system, age ≧ 65 years, redo session, and deep sedation, CFAE ablation was an independent predictor of the risk of complications (OR 1.78, P = .001). Specifically, implantation of a permanent pacemaker due to emerging sinus node dysfunction was frequent after CFAE ablation (CFAE [+] vs [−] = 4/1047 vs 2/9748, P < .001). Conclusions Among extra‐PV ablation strategies, CFAE‐guided ablation is a predictor of ablation‐related complications.