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Start Over Search Limiters Peer Reviewed Topic atrial fibrillation
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1. Procedure-Related Complications of Catheter Ablation for Atrial Fibrillation

Author

Karim Benali, Paul Khairy, Nefissa Hammache, Adrian Petzl, Antoine Da Costa, Atul Verma, Jason G. Andrade, Laurent Macle, Université de Montréal (UdeM), Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Montreal Heart Institute - Institut de Cardiologie de Montréal, McGill University Health Center [Montreal] (MUHC), Dr Benali has received grant support from the Group of Pacing and Cardiac Electrophysiology of the French Society of Cardiology. Dr Verma has received grant support, advisory board fees, and lecture fees from Bayer, Biosense Webster, and Medtronic, has received grant support from Biotronik, Bristol Myers Squibb, and Boehringer Ingelheim, has received consulting fees from Boston Scientific, MedLumics, and Thermedical, and has received lecture fees from Servier. Dr Andrade has received grant support from Baylis Medical, and and has received lecture fees from Biosense Webster. Dr Macle has received grant support and honoraria from Biosense Webster, Abbott, and Pfizer-Bristol Myers Squibb. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Subjects
meta-analysis, trend, catheter ablation, adverse event, atrial fibrillation, complication, [SDV.IB]Life Sciences [q-bio]/Bioengineering, randomized trials, Cardiology and Cardiovascular Medicine, mortality
Abstract

International audience; Background: Catheter ablation of atrial fibrillation (AF) is a commonly performed procedure. However, it is associated with potentially significant complications. Reported procedure–related complication rates are highly variable, depending in part on study design. Objectives: The purpose of this systematic review and pooled analysis was to determine the rate of procedure-related complications associated with catheter ablation of AF using data from randomized control trials and to assess temporal trends. Methods: MEDLINE and EMBASE databases were searched from January 2013 to September 2022 for randomized control trials that included patients undergoing a first ablation procedure of AF using either radiofrequency or cryoballoon (PROSPERO, CRD42022370273). Results: A total of 1,468 references were retrieved, of which 89 studies met inclusion criteria. A total of 15,701 patients were included in the current analysis. Overall and severe procedure-related complication rates were 4.51% (95% CI: 3.76%-5.32%) and 2.44% (95% CI: 1.98%-2.93%), respectively. Vascular complications were the most frequent type of complication (1.31%). The next most common complications were pericardial effusion/tamponade (0.78%) and stroke/transient ischemic attack (0.17%). The procedure-related complication rate during the most recent 5-year period of publication was significantly lower than during the earlier 5-year period (3.77% vs 5.31%; P = 0.043). The pooled mortality rate was stable over the 2 time periods (0.06% vs 0.05%; P = 0.892). There was no significant difference in complication rate according to pattern of AF, ablation modality, or ablation strategies beyond pulmonary vein isolation. Conclusions: Procedure-related complications and mortality rates associated with catheter ablation of AF are low and have declined in the past decade. © 2023 American College of Cardiology Foundation

Published
2023

2. Long-term risk of stroke and its predictors in transient ischaemic attack patients in Germany

Author

Karel Kostev, Louis Jacob, Christian Tanislav, Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), and The authors have received no financial support for the research, authorship and/or publication of this paper.

Subjects
Male, associated predictors, Cohort Studies, 0302 clinical medicine, general practices, Germany, Atrial Fibrillation, 030212 general & internal medicine, Stroke, Aged, 80 and over, Incidence, Hazard ratio, Age Factors, Atrial fibrillation, Middle Aged, stroke, 3. Good health, Neurology, Ischemic Attack, Transient, Hypertension, Cohort, Platelet aggregation inhibitor, Female, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Risk, medicine.medical_specialty, transient ischaemic attack, 03 medical and health sciences, Sex Factors, Diabetes mellitus, Internal medicine, parasitic diseases, medicine, Humans, long-term risk, In patient, cardiovascular diseases, Aged, Ischemic Stroke, business.industry, Anticoagulants, Protective Factors, medicine.disease, nervous system diseases, Long term risk, Neurology (clinical), business, Platelet Aggregation Inhibitors, 030217 neurology & neurosurgery
Abstract

International audience; Background and purpose: Little is known about the long-term association between transient ischaemic attack (TIA) and stroke. Therefore, the goal of this study was to analyze the long-term risk of stroke and associated predictors in a large cohort of TIA patients followed in general practices in Germany. Methods: This study included patients with an initial TIA diagnosis and subsequently followed up in one of 1262 general practices in Germany between January 2007 and December 2016 (N = 19 824 patients). The primary outcome of the study was the risk of ischaemic stroke within 10 years of the initial diagnosis of TIA. The secondary outcome was the identification of demographic, clinical and pharmaceutical variables significantly associated with stroke in TIA patients. Results: Within 10 years of the initial TIA diagnosis, 18.3% of individuals were diagnosed with stroke. Age was positively associated with stroke, with hazard ratios ranging from 1.88 in patients aged 51–60 years to 4.00 in those aged >80 years (reference group: patients aged ≤50 years). Furthermore, male sex, hypertension, diabetes mellitus, atrial fibrillation and ischaemic heart diseases had an additional impact on the risk of stroke. Finally, new oral anticoagulants, heparins, diuretics, angiotensin II receptor blockers and platelet aggregation inhibitors were identified as protective factors. Conclusions: In a cohort of almost 20 000 TIA patients, 18.3% were diagnosed with stroke within 10 years after the TIA index event. Several demographic, clinical and pharmaceutical variables significantly predicted the long-term risk of stroke in TIA patients.

Published
2020