What are the risks of an atrial fibrillation ablation procedure?
Radiofrequency ablation for atrial fibrillation has been developed over more than 10 years and is now a routine procedure in many hospitals around the world. Approximately 10 of these procedures are performed in a usual week at the Royal Melbourne and Melbourne Private Hospitals (Over 1500 AF ablations have been performed at these hospitals -November 2013). Although most people undergoing atrial fibrillation ablation do not experience any complications, you should be aware of the following possible risks (these will be discussed with you).
The risk of any complication is approximately 4 to 6%.
The risk of a major or serious complication is approximately 1 or 2% (1 to 2 in 100).
The risk of death as a complication of the procedure is approximately 1 in 1000.
Major complications (1-2% risk) include but are not limited to:
- Stroke (estimated at 0.5 to 1%)
- Damage to the heart wall (cardiac tamponade) or major artery (aorta) or heart valve. (These complications may require urgent open heart surgery to correct).
- Pulmonary vein stenosis (narrowing the blood vessels that enter the left atrium)
- Infection (including in the lung-pneumonia, or the heart-endocarditis)
- Blood clots to major organs (eg. brain, heart causing heart attack, lungs, kidneys, bowel)
- Large bleed in the groin or damage to the artery possibly requiring surgery and/or blood transfusion to correct
Rare but serious complications include:
- Damage to the oesophagus (the swallowing tube) termed an atrio-esophageal fistula. (this is considered to be a rare complication but is usually fatal).
- Damage to the esophagus from the trans-oesophageal echo probe.
- Damage to major nerves which run near to the heart (these include the nerve to the diaphragm or to the stomach)
- Damage to the normal electrical system of the heart resulting in a permanent pacemaker.
Other less severe complications include:
- Groin problems where the electrical catheters are inserted: bleeding, blood clot or large bruise.
- Occasionally there may be numbness on the front of the leg. Rarely this may persist for many months or longer.
- Rapid abnormal heart rhythm - in some cases a small electric shock may be required to restore your normal rhythm.
- Infection or bruising of an intravenous or intra-arterial cannula.
- Damage from the urinary catheter to the urethra causing pain and bleeding on urination. This usually resolves within days.
Do I need to undergo this procedure?
Atrial fibrillation ablation is designed to cure your symptoms and improve your quality of life. However, because the procedure carries a small risk of a major complication we recommend it only to those people having frequent episodes of atrial fibrillation or continuous atrial fibrillation where there is a significant impact on quality of life. We do not recommend the procedure for people who have minor or no symptoms or who feel that the condition represents only a relatively minor nuisance. We would also usually recommend a trial of medications first as some people will be well controlled on tablets (we understand that some people do not wish to take or cannot tolerate medications).