The authors of the article "Prevalence and Causes of Fatal Outcome in Catheter Ablation of Atrial Fibrillation" wrote that "knowledge of possible precipitating causes is key to operators and needs to be considered during decision making with patients."
The purpose of the study, led by Dr Ricardo Cappato, Arrhythmia and Electrophysiology Center, Policlinico San Donato, Milan, Italy, was to provide a systematic multicentre survey on the incidence and causes of death occurring in the setting of or as a consequence of catheter ablation of atrial fibrillation.
Using a retrospective case series, data relevant to the incidence and cause of intra- and post-procedural death occurring in patients undergoing ablation of atrial fibrillation between 1995 and 2006 were collected from 162 of 546 identified centres worldwide.
Thirty-two deaths (.98 per 1,000 patients) were reported during 45,115 procedures in 32,569 patients. Causes of deaths included tamponade in eight patients (one later than 30 days), stroke in five patients (two later than 30 days), atrioesophageal fistula in five patients, and massive pneumonia in two patients. Myocardial infarction, intractable torsades de pointes, septicemia, sudden respiratory arrest, extrapericardial pulmonary vein perforation, occlusion of both lateral pulmonary veins, hemothorax, and anaphylaxis were reported to be responsible for one death each, while asphyxia from tracheal compression secondary to subclavian hematoma, intracranial bleeding, acute respiratory distress syndrome, and esophageal perforation from an intraoperative transesophageal echocardiographic probe were causes of one late death each.