Open AccessIncidence and predictors of pericardial effusion as an early complication of catheter ablation for atrial fibrillation: The Japanese Catheter Ablation Registry of Atrial Fibrillation (J‐CARAF)
Author(s) -
Murakawa Yuji,
Yamane Teiichi,
Goya Masahiko,
Inoue Koichi,
Naito Shigeto,
Kumagai Koichiro,
Miyauchi Yasushi,
Morita Norishige,
Nogami Akihiko,
Shoda Morio,
Okumura Ken,
Hirao Kenzo
Publication year - 2017
Publication title -
journal of arrhythmia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.463
H-Index - 21
eISSN - 1883-2148
pISSN - 1880-4276
DOI - 10.1016/j.joa.2017.04.009
Subject(s) - medicine , atrial fibrillation , pericardial effusion , catheter ablation , ablation , incidence (geometry) , cardiology , odds ratio , complication , univariate analysis , surgery , multivariate analysis , physics , optics
Background Pericardial effusion (PE) is one of the most frequent complications from catheter ablation of atrial fibrillation (AF). We assessed the prevalence and predictive factors of PE that require invasive treatment as an early complication of AF ablation. Methods The Japanese Heart Rhythm Society requested electrophysiology centers to register the relevant data of patients who underwent AF ablation during 6 months from 2011 to 2015. We compared the clinical profiles and the procedures of AF ablation between patients who had ablation‐related PE and those who did not. Results Two‐hundred‐and‐eight institutions reported the data of 8319 AF ablation sessions (age 63.4±10.7 years). A total of 414 complications occurred in 401 patients (4.8%). The incidence of invasively treated critical PE was 1.0% (n=85) of total procedures, while conservatively treated noncritical PE appeared in 95 subjects. When clinical and procedural variables were compared between patients who suffered critical PE and 8140 PE‐free patients, deep sedation (p=0.030), impaired left ventricular function (p=0.031), and periprocedural warfarin (p=0.023) significantly increased the incidence of critical PE in univariate analysis. Use of 3‐D imaging system (p<0.001) and a periprocedural direct oral anticoagulant (DOAC, p=0.002) were related with lower incidence of critical PE. Among these factors, multivariate logistic regression analysis showed that 3‐D imaging system (odds ratio 0.23 [95% CI: 0.14–0.39], p<0.001) and a periprocedural DOAC (odds ratio 0.49 [95% CI: 0.27–0.90], p=0.020) are independent predictors of the lower incidence of PE. Conclusions Critical PE occurred in 1% of AF ablation procedures in Japan. Our results suggest that 3‐D imaging system use independently reduces the frequency of PE. DOACs in the setting of catheter ablation of AF seemed to be non‐inferior to warfarin in terms of safety and effectiveness.