Clinical and procedural predictors of early complications of ablation for atrial fibrillation: Analysis of the national registry data

Background The risk assessment of the complication from atrial fibrillation (AF) ablation is important and needs to be updated. Objective The purpose of this study was to investigate the clinical and procedural factors associated with AF ablation-related early complications. Methods The Japanese Heart Rhythm Society invited electrophysiology centers in Japan to register data regarding all AF ablation procedures performed in September 2011, March 2012, and September 2012. Of the 46 putative predictors assessed in the univariate analysis, significant variables ( P < .1) were entered into a stepwise logistic regression model for multivariate analysis. Results Data for 3373 cases were submitted by 165 centers, with 158 early complications reported in 151 patients (4.5%). We identified 13 significant variables in the univariate analysis. Multivariate analysis revealed that 8 (62%) of them were independent predictors of early complications. Female sex (odds ratio and 95% confidence interval 1.6; 1.13–2.27), hypertrophic cardiomyopathy (2.2; 1.08–4.5), valvular heart disease (2.53; 1.28–5.05), deep sedation during the procedure (1.53; 1.09–2.12), and complex fractionated atrial electrocardiogram ablation (1.88; 1.23–2.87) increased early complications. Preprocedural transesophageal echocardiography (0.63; 0.43–0.92), irrigated-tip catheter use (0.46; 0.3–0.69), and periprocedural novel oral anticoagulant use (0.55; 0.32–0.97) decreased them. Conclusion The risk of early complications is increased by female sex, hypertrophic cardiomyopathy, valvular heart disease, deep sedation, and complex fractionated atrial electrocardiogram ablation. It is decreased by preprocedural transesophageal echocardiography, periprocedural novel oral anticoagulant, and irrigated-tip catheter use.