Predictors of Complications Related to Cardiac Ablation for Atrial Arrhythmias

Abstract

The heterogeneity of the patient population and the lack of uniform approaches to periprocedural management highlight the importance of investigating the predictors of catheter ablation (CA) related complications in patients with atrial arrhythmias.Aim of the study: to identify risk factors for procedure-related (PR) and procedural sedation and analgesia (PSA)-related complications in patients with atrial arrhythmias.Materials and Methods. A single-center retrospective cohort observational study analyzed 2,340 electronic medical records (EMRs) from the I.I. Mechnikov NWSMU database from 2015 to 2022. A total of 1,793 EMRs were included in the study. All the patients underwent radiofrequency CA for atrial arrhythmia under procedural sedation and analgesia. The risk factors for PR- and PSA-related complications were identified using single-factor regression analysis and multivariate logistic regression with Jamovi 2.3.21 and IBM SPSS Statistics 26 software.Results. The PR- and PSA-related complication rates were 3.29% and 0.73 %, respectively. Hemopericardium/cardiac tamponade with an incidence of 1.45% and cerebral stroke/TIA documented in 1.17% of cases predominated among the PR complications. PSA-related complications included postoperative nausea and vomiting syndrome (0.22 %) and respiratory depression (requiring mechanical ventilation in 0.06% and non-invasive ventilation in 0.45%). Of all PR complications, 30.5% were documented in patients aged 70-74 years. BMI >30.0 kg/m2 (adjusted OR, 1.963; 95% CI, 1.09-3.36; P=0.023), age >69 years (adjusted OR, 3.081; 95% CI, 1.764-5.383; P<0.001), pain severity on the numerical rating scale (NRS) >3 points (adjusted OR, 4.317; 95% CI, 2.390-7.800; P<0.001), and previous CA procedure in the patient's history (adjusted OR, 10.276; 95% CI, 4.006-26.354; P<0.001) were found to be risk factors for the development of PR complications, whereas BMI >35 kg/m2 (adjusted OR, 4.955; 95% CI, 1.485-16.535; P=0.009) and duration of CA procedure >142 min (adjusted OR, 11.070; 95% CI, 2.440-50.228; P=0.002) were found to be risk factors of PSA complications.Conclusion. The following independent predictors of CA-related complications were identified: patient-related factors such as BMI >30.0 kg/m2 and age >69 years, as well as procedure-related factors such as duration of CA >142 min, history of CA, and pain intensity >3 NPRS points.

Keywords

• procedural complications
• catheter ablation
• risk factors
• atrial arrhythmias
• procedural sedation and analgesia