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Detecting
Post –Ablation
Complications
Diane Sauro MSN, ANP
Electrophysiology
Duke University Medical Center
What can go Wrong?
Major Complications
Death
Tamponade
Atrio-Esophageal-Fistula
Pulmonary Vein Stenosis
Stroke/TIA
Sepsis
...
Worldwide Survey of Complications
(self-reporting)
181 centers; 1995-2002
Cappato et al. Circulation 2005;111:1100-1105
De...
Updated Survey
182 centers
20,825 procedures
16,309 patients
2003-2006
Cappato et al. Circ Arrhythm Electrophysiol 2010;3:...
Real World Complications:
The California State Inpatient Database
Shah et al. J Am Coll Cardiol 2012;59:143–9
Patients wit...
Worse Case Scenario survival
Guide
Death
Case Study
• MB is a 78 y o female
• Post Atrial fibrillation ablation.
• Complaint of SOB chest pain.
• VS HR 120 BP 60/d...
Tamponade
Signs & Symptoms
• Hypotension
• Distention of neck veins
• Distant Heart sounds
• Pulus Paradoxus
• Sinus Tachy...
Treatment
• Pericardiocentesis
• Volume (only if hypotensive )
• Inotropes
Case study
• SJ is a 45 year old male Post VT ablation
• He complains of severe chest pain worse with deep
inspiration , S...
EKG
Pericarditis
Inflammation of the pericardium
Signs and Symptoms
• Acute: EKG with ST elevation in multiple leads
• Chest p...
Treatment
• Anti-Inflammatory
In patients with acute pericarditis, colchicine,
when added to conventional anti-inflammator...
Case Study
• MM is a 64 yo female post afib ablation 2 weeks ago
• She presents with complaint of Fever, dysphagia and
Hea...
A, Transverse section of chest computed tomography scan, revealing air in left atrial
appendage and left superior pulmonar...
Atrio-Esophegeal Fistula
Symptoms
• Fever
• Malaise
• Dysphasia
• Neurologic symptoms
Diagnostics
• CT or MRI of chest may...
Esophageal Injury
Treatmentand Prevention
• Esophagus is posterior to LA and to right of descending
aorta
Treatment
• Prot...
Case Study
• BH is a 54 yo post a fib ablation
• She presents with complaint of progessive DOE , chest
pain, cough
• VS HR...
Pulmonary Vein Stenosis
• The reduction of diameter of PV or PV Branch
Mild < 50%
Moderate 50-70%
Severe >70%
Pulmonary vein stenosis
Symptoms
• Chest Pain
• Progressive Dyspnea
on Exertion
• Cough
• Hemoptysis
• Recurrent lung
infe...
Vascular complications
Hematoma
AV Fistula
Pseudo aneurysm
Vagal Nerve Injury
SYMPTOMS:
Nausea , vomiting,
Bloating and abdominal pain
Phrenic Nerve paralysis
SYMPTOMS
Dyspnea
Hiccups
Atelectasis
Pleura effusion
Cough
Thoracic Pain
RDU Worse Case scenario Feb 2014
We Survived
Duke Gardens
EP Summit 2015: Detecting Post-ablation Complications
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EP Summit 2015: Detecting Post-ablation Complications

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Diane Sauro

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EP Summit 2015: Detecting Post-ablation Complications

  1. 1. Detecting Post –Ablation Complications Diane Sauro MSN, ANP Electrophysiology Duke University Medical Center
  2. 2. What can go Wrong? Major Complications Death Tamponade Atrio-Esophageal-Fistula Pulmonary Vein Stenosis Stroke/TIA Sepsis Vascular Complications Pericarditis Vagal Nerve injury Phrenic Nerve paralysis
  3. 3. Worldwide Survey of Complications (self-reporting) 181 centers; 1995-2002 Cappato et al. Circulation 2005;111:1100-1105 Death 1:1000; survey of 45,115 procedures, 1995-2006; 162 centers Cappato et al. J Am Coll Cardiol 2009;53:1798–803
  4. 4. Updated Survey 182 centers 20,825 procedures 16,309 patients 2003-2006 Cappato et al. Circ Arrhythm Electrophysiol 2010;3:32-38
  5. 5. Real World Complications: The California State Inpatient Database Shah et al. J Am Coll Cardiol 2012;59:143–9 Patients with 1st AF ablation 2005-2008 4,156 patients
  6. 6. Worse Case Scenario survival Guide
  7. 7. Death
  8. 8. Case Study • MB is a 78 y o female • Post Atrial fibrillation ablation. • Complaint of SOB chest pain. • VS HR 120 BP 60/dop resp 32
  9. 9. Tamponade Signs & Symptoms • Hypotension • Distention of neck veins • Distant Heart sounds • Pulus Paradoxus • Sinus Tachycardia • Anxiety • Tachypneic • Shortness of Breath What you should do • Get an Echo • Check pulsus paradoxus • EKG
  10. 10. Treatment • Pericardiocentesis • Volume (only if hypotensive ) • Inotropes
  11. 11. Case study • SJ is a 45 year old male Post VT ablation • He complains of severe chest pain worse with deep inspiration , SOB • VS HR 86 BP 120/86, Resp 24
  12. 12. EKG
  13. 13. Pericarditis Inflammation of the pericardium Signs and Symptoms • Acute: EKG with ST elevation in multiple leads • Chest pain with deep inspiration May increase with coughing, swallowing, deep breathing or lying flat • Can be relieved by sitting up and leaning forward • Pain in the back, neck or left shoulder • Difficulty breathing when lying down • A dry cough • Anxiety or fatigue
  14. 14. Treatment • Anti-Inflammatory In patients with acute pericarditis, colchicine, when added to conventional anti-inflammatory therapy, significantly reduced the rate of incessant or recurrent pericarditis. N Engl J Med 2013;369:1522-8.
  15. 15. Case Study • MM is a 64 yo female post afib ablation 2 weeks ago • She presents with complaint of Fever, dysphagia and Headache • VS HR 84 NSR, BP 110/62 Resp 22
  16. 16. A, Transverse section of chest computed tomography scan, revealing air in left atrial appendage and left superior pulmonary artery. D’Avila A et al. Circulation. 2007;115:e432-e433 Copyright © American Heart Association, Inc. All rights reserved.
  17. 17. Atrio-Esophegeal Fistula Symptoms • Fever • Malaise • Dysphasia • Neurologic symptoms Diagnostics • CT or MRI of chest may reveal Mediastinal or intravascular air • Treatment • Immediate Surgical Intervention
  18. 18. Esophageal Injury Treatmentand Prevention • Esophagus is posterior to LA and to right of descending aorta Treatment • Proton Pump Inhibitor BID for 30 days • Occasionally Sucralfate
  19. 19. Case Study • BH is a 54 yo post a fib ablation • She presents with complaint of progessive DOE , chest pain, cough • VS HR 76 NSR, BP 140/88 Resp 24 TESTING: • CT Chest
  20. 20. Pulmonary Vein Stenosis • The reduction of diameter of PV or PV Branch Mild < 50% Moderate 50-70% Severe >70%
  21. 21. Pulmonary vein stenosis Symptoms • Chest Pain • Progressive Dyspnea on Exertion • Cough • Hemoptysis • Recurrent lung infections • Pulmonary Hypertension Treatment Pulmonary Vein Angioplasty
  22. 22. Vascular complications Hematoma AV Fistula Pseudo aneurysm
  23. 23. Vagal Nerve Injury SYMPTOMS: Nausea , vomiting, Bloating and abdominal pain
  24. 24. Phrenic Nerve paralysis SYMPTOMS Dyspnea Hiccups Atelectasis Pleura effusion Cough Thoracic Pain
  25. 25. RDU Worse Case scenario Feb 2014 We Survived
  26. 26. Duke Gardens

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