Circulation, Vol 84, 1924-1937, Copyright © 1991 by American Heart Association
GT Evans Jr, MM Scheinman, G Bardy, M Borggrefe, P Brugada, J Fisher, G Fontaine, SK Huang, WH Huang and M Josephson
BACKGROUND. The Catheter Ablation Registry was the first international,
multicenter, prospective study of the safety and efficacy of catheter
ablation. METHODS AND RESULTS. From August 1987 through March 1990, the
study comprised 136 patients in whom only DC energy was used in attempted
production of third-degree atrioventricular block to treat uncontrollable
supraventricular tachycardias. Eight patients died during hospitalization
for ablation. In seven (5.1%), the ablation may have contributed to their
deaths. Causes of death included ventricular fibrillation (five patients,
three with polymorphic ventricular tachycardia), progressive heart failure
(one patient), and respiratory failure (two patients, one dying after
resuscitation from ventricular fibrillation). Compared with survivors,
patients who died were more likely to have had prior aborted sudden death
(38% versus 2%, p less than 0.05), congestive heart failure (88% versus
22%, p less than 0.001), cardiomyopathy (50% versus 16%, p less than 0.05),
lower baseline systolic blood pressure (106 versus 138 mm Hg, p less than
0.001), prolonged baseline and postablation corrected QT interval (p less
than 0.01), and markedly reduced ejection fraction (27% versus 52%, p less
than 0.001). Ablation successfully produced third-degree atrioventricular
block in 88% of the patients who died and in 83% of survivors. CONCLUSIONS.
Catheter ablation of the atrioventricular junction with DC energy carries a
significant, previously unrecognized risk of death (5.1%), particularly
from lethal arrhythmias, when applied to patients with severe left
ventricular dysfunction. Great care should be taken in these seriously ill
patients to guard against postablation ventricular arrhythmias.
ARTICLES
Predictors of in-hospital mortality after DC catheter ablation of atrioventricular junction. Results of a prospective, international, multicenter study
Department of Medicine, University of California, San Francisco.
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