HRS Guidelines Bundle (free trial)

16 Treatment Table 7. Definitions of Complications Associated with AF Ablation Term Definition Asymptomatic cerebral embolism Asymptomatic cerebral embolism (ACE) is defined as an occlusion of a blood vessel in the brain due to an embolus that does not result in any acute clinical symptoms. Silent cerebral embolism is generally detected using a diffusion weighted MRI. Atrioesophageal fistula An atrioesophageal fistula is defined as a connection between the atrium and the lumen of the esophagus. Evidence supporting this diagnosis includes documentation of esophageal erosion combined with evidence of a fistulous connection to the atrium such as air emboli, an embolic event, or direct observation at the time of surgical repair. A CT scan or MRI scan is the most common method of documenting an atrioesophageal fistula. Bleeding Bleeding is defined as a major complication of AF ablation if it requires and/or is treated with transfusion or results in a 20% or greater fall in hematocrit (HCT). Bleeding following cardiac surgery Excessive bleeding following a surgical AF ablation procedure is defined as bleeding requiring reoperation or ≥2 units of PRBC transfusion within any 24 hours of the first 7 days following the index procedure. Cardiac perforation We recommend that cardiac perforation be defined together with cardiac tamponade. See "Cardiac tamponade/perforation." Cardiac tamponade We recommend that cardiac tamponade be defined together with cardiac perforation. See "Cardiac tamponade/perforation." Cardiac tamponade/ perforation Cardiac tamponade/perforation is defined as the development of a significant pericardial effusion during or within 30 days of undergoing an AF ablation procedure. A significant pericardial effusion is one that results in hemodynamic compromise, requires elective or urgent pericardiocentesis, or results in a 1-cm or more pericardial effusion as documented by echocardiography. Cardiac tamponade/perforation should also be classified as "early" or "late" depending on whether it is diagnosed during or following initial discharge from the hospital. Deep sternal wound infection/ mediastinitis following cardiac surgery Deep sternal wound infection/mediastinitis following cardiac surgery requires one of the following : (1) an organism isolated from culture of mediastinal tissue or fluid; (2) evidence of mediastinitis seen during operation; (3) one of the following conditions: chest pain, sternal instability, or fever (>38°C), in combination with either purulent discharge from the mediastinum or an organism isolated from blood culture or culture of mediastinal drainage. Esophageal injury Esophageal injury is defined as an erosion, ulceration, or perforation of the esophagus. e method of screening for esophageal injury should be specified. Esophageal injury can be a mild complication (erosion or ulceration) or a major complication (perforation).

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