Effects of Gender on the Incidence of Cardiac Tamponade Following Catheter Ablation of Atrial Fibrillation: Results from a Worldwide Survey in 34,943 AF Ablation Procedures.

Michowitz, Yoav; Rahkovich, Michael; Oral, Hakan; Zado, Erica S.; Tilz, Roland; John, Silke; Denis, Arnaud; Di Biase, Luigi; Winkle, Roger A.; Mikhaylov, Evgeny N.; Ruskin, Jeremy N.; Yao, Yan; Josephson, Mark E.; Tanner, Hildegard; Miller, John M.; Champagne, Jean; Della Bella, Paolo; Kumagai, Koichiro; Defaye, Pascal; Luria, David; ... (2014). Effects of Gender on the Incidence of Cardiac Tamponade Following Catheter Ablation of Atrial Fibrillation: Results from a Worldwide Survey in 34,943 AF Ablation Procedures. Circulation. Arrhythmia and electrophysiology, 7(2), pp. 274-280. Lippincott Williams & Wilkins 10.1161/CIRCEP.113.000760

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BACKGROUND

-Cardiac tamponade is the most dramatic complication observed during atrial fibrillation (AF) ablation and the leading cause of procedure-related mortality. Female gender 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 electrophysiologic (EP) centers that reported cases of tamponade occurring during AF ablation. Centers were asked to provide information on cases of acute tamponade according to gender and their mode of management including any case of related mortality. Nineteen EP centers provided information on 34,943 ablation procedures involving 25,261 (72%) males. Overall 289 (0.9%) cases of tamponade were reported: 120 (1.24%) in females and 169 (0.67%) in males (odds ratio 1.83, P<0.001). There was a reciprocal association between center volume and the occurrence of tamponade with substantial lower risk in high volume centers. Most cases of tamponade occurred during catheter manipulation or ablation; females tended to develop more tamponades during transseptal catheterization. No gender 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 almost twofold higher risk for developing this complication. The risk of tamponade among women decreases substantially in high volume centers. Surgical back-up and acute management skills for treating tamponade are important in centers performing AF ablation.

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