HRS Guidelines Bundle (free trial)

17 Gastric motility/ pyloric spasm disorders Gastric motility/pyloric spasm disorder should be considered a major complication of AF ablation when it prolongs or requires hospitalization, requires intervention, or results in late disability, such as weight loss, early satiety, diarrhea, or gastrointestinal (GI) disturbance. Major complication A major complication is a complication that results in permanent injury or death, requires intervention for treatment, or prolongs or requires hospitalization for more than 48 hours. Because early recurrences of atrial fibrillation/atrial flutter/atrial tachycardia (AF/AFL/AT) are to be expected following AF ablation, recurrent AF/AFL/AT within 3 months that requires or prolongs a patient's hospitalization should not be considered to be a major complication of AF ablation. Mediastinitis Mediastinitis is defined as inflammation of the mediastinum. Diagnosis 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. Myocardial infarction (MI) in the context of AF ablation e universal definition of MI cannot be applied in the context of catheter or surgical AF ablation procedures because it relies heavily on cardiac biomarkers (troponin and creatine phosphokinase [CPK]) that are anticipated to increase in all patients who undergo AF ablation as a result of the ablation of myocardial tissue. Similarly, chest pain and other cardiac symptoms are difficult to interpret in the context of AF ablation both because of the required sedation and anesthesia and also because most patients experience chest pain following the procedure as a result of the associated pericarditis which occurs following catheter ablation. We therefore propose that an MI, in the context of catheter or surgical ablation, be defined as the presence of any one of the following criteria: (1) detection of ECG changes indicative of new ischemia (new ST-T changes or new le bundle branch block [LBBB]) that persist for more than 1 hour; (2) development of new pathological Q waves on an ECG; (3) imaging evidence of new loss of viable myocardium or new regional wall motion abnormality. Pericarditis Pericarditis should be considered a major complication following ablation if it results in an effusion which leads to hemodynamic compromise or requires pericardiocentesis, prolongs hospitalization by more than 48 hours, requires hospitalization, or persists for more than 30 days following the ablation procedure. Table 7. Definitions of Complications Associated with AF Ablation (cont'd) Term Definition

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