Department   School of Medicine(Tokyo Women's Medical University Hospital), School of Medicine
   Position   Endowed Professor
Article types Original article
Language English
Peer review Peer reviewed
Title Incidence and predictors of pericardial effusion as an early complication of catheter ablation for atrial fibrillation: The Japanese Catheter Ablation Registry of Atrial Fibrillation (J-CARAF).
Journal Formal name:Journal of arrhythmia
Abbreviation:J Arrhythm
ISSN code:1880-4276/1883-2148
Domestic / ForeginDomestic
Publisher Japanese Heart Rhythm Society
Volume, Issue, Page 33(5),pp.430-433
Author and coauthor Murakawa Yuji, Yamane Teiichi, Goya Masahiko, Inoue Koichi, Naito Shigeto, Kumagai Koichiro, Miyauchi Yasushi, Morita Norishige, Nogami Akihiko, Shoda Morio, Okumura Ken, Hirao Kenzo,
Publication date 2017/10
Pericardial effusion (PE) is one of the most frequent complications from catheter ablation of atrial fibrillation (AF). We assessed the prevalence and predictive factors of PE that require invasive treatment as an early complication of AF ablation.

The Japanese Heart Rhythm Society requested electrophysiology centers to register the relevant data of patients who underwent AF ablation during 6 months from 2011 to 2015. We compared the clinical profiles and the procedures of AF ablation between patients who had ablation-related PE and those who did not.

Two-hundred-and-eight institutions reported the data of 8319 AF ablation sessions (age 63.4±10.7 years). A total of 414 complications occurred in 401 patients (4.8%). The incidence of invasively treated critical PE was 1.0% (n=85) of total procedures, while conservatively treated noncritical PE appeared in 95 subjects. When clinical and procedural variables were compared between patients who suffered critical PE and 8140 PE-free patients, deep sedation (p=0.030), impaired left ventricular function (p=0.031), and periprocedural warfarin (p=0.023) significantly increased the incidence of critical PE in univariate analysis. Use of 3-D imaging system (p<0.001) and a periprocedural direct oral anticoagulant (DOAC, p=0.002) were related with lower incidence of critical PE. Among these factors, multivariate logistic regression analysis showed that 3-D imaging system (odds ratio 0.23 [95% CI: 0.14-0.39], p<0.001) and a periprocedural DOAC (odds ratio 0.49 [95% CI: 0.27-0.90], p=0.020) are independent predictors of the lower incidence of PE.

Critical PE occurred in 1% of AF ablation procedures in Japan. Our results suggest that 3-D imaging system use independently reduces the frequency of PE. DOACs in the setting of catheter ablation of AF seemed to be non-inferior to warfarin in terms of safety and effectiveness.
DOI 10.1016/j.joa.2017.04.009
PMID 29021845