European Heart Rhythm Association survey on the perceived severity of complications in atrial fibrillation ablation: development of a standardized scoring model

Stefano Bordignon

doi:10.1093/europace/euaf254

European Heart Rhythm Association survey on the perceived severity of complications in atrial fibrillation ablation: development of a standardized scoring model

2025-11-01

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DOI：10.1093/europace/euaf254

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Aims Atrial fibrillation (AF) ablation is associated with complications. These are sometimes categorized as mild or severe based on unspecified criteria. We conducted a survey of European electrophysiologists (EPs) to rank the perceived complication severity.Methods and results A physician-based survey was conducted by the Scientific Initiative Committee of the European Heart Rhythm Association (EHRA). An online questionnaire was created asking EPs to score a list of complications on a scale from 0 (no complication) to 100 (procedural death). Three hundred respondents participated in the survey; however, 105 were excluded due to incomplete responses. Unexplained periprocedural death (90, interquartile range 50-100), atrio-oesophageal fistula (AEF 92, 80-100), procedural stroke (80, 59-89), and tamponade requiring surgery (70, 80-83) were the complications associated with highest scores. Among the intermediate complications, phrenic nerve palsy at discharge (49, 25-67) was ranked similarly to tamponade treated with pericardial puncture (50, 25-70) or periprocedural transient ischaemic attack (50, 25-70). Institutional infrastructural features such as cardiac surgery or stroke units had no impact on the scoring. Most respondents (89%) have experienced cardiac tamponade, procedural stroke (53%), and AEF (25%). When applied retrospectively to existing studies, the proposed EHRA AF ablation safety score demonstrated a trend towards improved AF ablation safety over time.Conclusion The EHRA complication severity score provides a standardized, quantitative ranking of AF ablation complications, identifying periprocedural death and AEF as the most severe events. Based on the findings, we propose a novel EHRA AF ablation safety score that may contribute to a more objective safety comparison of AF ablation trials.

Keywords:

Atrial fibrillation

Complication

Score

Safety

Survey

European Heart Rhythm Association survey on the perceived severity of complications in atrial fibrillation ablation: development of a standardized scoring model

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