Describe complications resulting from ablative therapy for atrial fibrillation
State imaging findings of ablative therapy complications
List important indirect CT findings that should raise suspicion for ablative therapy complications.
Atrial fibrillation is the most common sustained cardiac arrhythmia,
and the incidence is rising.
Medical treatment includes anticoagulation with its inherent risks,
rate control pharmacotherapy with its 60% failure rate at 2 years,
and surgery (Maze procedure) with its surgical risks.
Percutaneous catheter ablation therapy offers less invasive curative therapy without need for anticoagulation.
Complications of catheter ablative therapy occur in less than 4% of patients and range from pericarditis to often fatal atrioesophageal fistula.
Imaging findings OR procedure details
Stenosis or occlusion of one or more pulmonary veins
Initial series reported rates up to 20% of patients,
although more recent series show rates under 10%,
most less than 5%.
Mild stenosis usually requires no intervention(Fig. 1). However,
progressive or severe stenosis requires prompt intervention to avoid pulmonary vein occlusion(Fig. 2)(Fig. 3).Currently,
there are no formal recommendations to screen patients for pulmonary vein stenosis
Cardiac CT or MRI can be used to evaluate the pulmonary veins in patients with known or suspected pulmonary vein stenosis....
Complications following ablative therapy for atrial fibrillationare uncommon,
and published rates have decreased as experience has increased and techniques have improved. The majority of complications are mild and can be transient.
prompt diagnosis of more severe or potentially severe complications is important to reduce morbidity and mortality.
CT is the preferred noninvasive imaging examination to evaluate patients for complication of transcatheter ablative therapy for atrial fibrillation.
Complications of catheter ablation for atrial fibrillation.Cor et Vasa.
risk factors and management of
pericardial effusion post radiofrequency catheter ablation in patients with
Zhonghua Xin Xue Guan Bing Za Zhi. 2008 Sep;36(9):801-6.
le Polain de Waroux JB,
following atrial fibrillation ablation procedure: diagnosis with cardiac CT.
Intensive Care Med.
Comparison of Phrenic Nerve Injury during Atrial
Chest Radiologists Collaborative:
Professor and Chief of Thoracic Imaging
Department of Radiology
University of Wisconsin School of Medicine and Public Health