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Table 16. Complications of Radiofrequency Catheter
Ablation for AF
Complication Symptoms/Signs Treatment
Air embolism Acute ischemia, cardiac
arrest, AV block,
hypotension
Supplemental oxygen,
fluids, CPR, or pacing if
indicated
Atrial-esophageal fistula Usually 1-4 wk aer
ablation, dysphagia,
unexplained fever, chills,
sepsis, neurological events
(septic emboli)
CT or MRI of esophagus,
avoiding endoscopy,
immediate surgical
correction
Cardiac tamponade/
perforation
Abrupt or gradual fall in
blood pressure
Pericardiocentesis,
emergent surgical drainage
if pericardiocentesis fails
Phrenic nerve injury
resulting in diaphragmatic
paralysis
Shortness of breath,
elevated hemidiaphragm
None, usually resolves
spontaneously
Iatrogenic atrial flutter Tachycardia Cardioversion,
antiarrhythmic drugs, or
repeat ablation
Gastric motility disorder Nausea, vomiting, bloating,
abdominal pain
Depends on severity of
symptoms
Mitral valve injury
requiring surgery
Entrapment of catheter Advance sheath with
gentle catheter retraction,
surgical removal
MI Chest pain, ST changes,
hypotension
Standard therapy
Pericarditis Chest pain, typical quality NSAIDs, colchicine,
steroids
Pulmonary vein stenosis Shortness of breath, cough,
hemoptysis
PV dilation/stent or no
therapy
Radiation injury Pain and reddening at
radiation site, can present
late
Treat as burn injury
Stroke or TIA Neurological deficit Consider lysis therapy
Death N/A N/A
Vascular access complication
Femoral pseudoaneurysm Pain or pulsatile mass at
groin
Observation, compression,
thrombin injection,
possible surgery
Arteriovenous fistula Pain, bruit at groin site Observation, compression,
possible surgery
Hematoma Pain, swelling Compression
Death N/A NA
