Effects of sex on the incidence of cardiac tamponade after catheter ablation of atrial fibrillation results from a worldwide survey in 34 943 atrial fibrillation ablation procedures

Yoav Michowitz, Michael Rahkovich, Hakan Oral, Erica S. Zado, Roland Tilz, Silke John, Arnaud Denis, Luigi Di Biase, Roger A. Winkle, Evgeny N. Mikhaylov, Jeremy N. Ruskin, Yan Yao, Mark E. Josephson, Hildegard Tanner, John M. Miller, Jean Champagne, Paolo Della Bella, Koichiro Kumagai, Pascal Defaye, David LuriaDmitry S. Lebedev, Andrea Natale, Pierre Jais, Gerhard Hindricks, Karl Heinz Kuck, Francis E. Marchlinski, Fred Morady, Bernard Belhassen

Research output: Contribution to journalArticle

50 Scopus citations

Abstract

Background-Cardiac tamponade is the most dramatic complication observed during atrial fibrillation (AF) ablation and the leading cause of procedure-related mortality. Female sex is a known risk factor for complications during AF ablation; however, it is unknown whether women have a higher risk of tamponade. Methods and Results-A systematic Medline search was used to locate academic electrophysiological centers that reported cases of tamponade occurring during AF ablation. Centers were asked to provide information on cases of acute tamponade according to sex and their mode of management including any case of related mortality. Nineteen electrophysiological centers provided information on 34 943 ablation procedures involving 25 261 (72%) men. Overall, 289 (0.9%) cases of tamponade were reported: 120 (1.24%) in women and 169 (0.67%) in men (odds ratio, 1.83; P<0.001). There was a reciprocal association between center volume and the occurrence of tamponade with substantially lower risk in highvolume centers. Most cases of tamponade occurred during catheter manipulation or ablation; women tended to develop more tamponades during transseptal catheterization. No sex difference in the mode of management was observed. However, 16% cases of tamponade required surgery with lower rates in high-volume centers. Three cases of tamponade (1%) culminated in death. Conclusions-Tamponade during AF ablation procedures is relatively rare. Women have an ̃2-fold higher risk for developing this complication. The risk of tamponade among women decreases substantially in high-volume centers. Surgical backup and acute management skills for treating tamponade are important in centers performing AF ablation.

Original languageEnglish (US)
Pages (from-to)274-280
Number of pages7
JournalCirculation: Arrhythmia and Electrophysiology
Volume7
Issue number2
DOIs
StatePublished - Apr 2014

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Keywords

  • Atrial fibrillation
  • Cardiac tamponade
  • Catheter ablation
  • Sex

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Michowitz, Y., Rahkovich, M., Oral, H., Zado, E. S., Tilz, R., John, S., Denis, A., Di Biase, L., Winkle, R. A., Mikhaylov, E. N., Ruskin, J. N., Yao, Y., Josephson, M. E., Tanner, H., Miller, J. M., Champagne, J., Bella, P. D., Kumagai, K., Defaye, P., ... Belhassen, B. (2014). Effects of sex on the incidence of cardiac tamponade after catheter ablation of atrial fibrillation results from a worldwide survey in 34 943 atrial fibrillation ablation procedures. Circulation: Arrhythmia and Electrophysiology, 7(2), 274-280. https://doi.org/10.1161/CIRCEP.113.000760