Aortic Regurgitation as a Complication of Electrophysiologic Ablation Techniques: A Narrative Review

Esraa Shehata; Mohamed Samy Abdel-Samie; Ahmad Elkoumy; Ahmed Yehia; Osama Soliman; Mohammad Abdelghani

doi:10.2174/1573403X17666210408093447

Aortic Regurgitation as a Complication of Electrophysiologic Ablation Techniques: A Narrative Review

Curr Cardiol Rev. 2021;17(6):e051121192738. doi: 10.2174/1573403X17666210408093447.

Authors

Esraa Shehata¹, Mohamed Samy Abdel-Samie², Ahmad Elkoumy³, Ahmed Yehia⁴, Osama Soliman⁵, Mohammad Abdelghani⁶

Affiliations

¹ Cardiology Department, Nasser Institute for Research and Treatment, Cairo, Egypt.
² Electrophysiology Unit, Cardiology Department, Al-Azhar University, Cairo, Egypt.
³ National University of Ireland, Galway, Ireland.
⁴ Arrhythmology Unit, Cardiology Department, Ain-Shams University, Cairo, Egypt.
⁵ Galway University Hospital, SAOLTA Health Care Group, Galway, Ireland | National University of Ireland, Galway, Ireland.
⁶ Cardiology Department, Al-Azhar University, Cairo, Egypt | Cardiology Department, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.

Abstract

Background: Radiofrequency catheter ablation is a well-established treatment for several cardiac arrhythmias. Arrhythmias originating from the left side of the heart including ventricular and supraventricular tachycardia and ectopy can be successfully ablated through either transseptal or retrograde aortic approach. Although these techniques have a generally low rate of complications, aortic valve injury is a potential complication of ablation at the left cardiac side that warrants more investigation.

Objective: The purpose of this review is to evaluate the incidence of iatrogenic aortic valve regurgitation and explore the potential mechanisms and risk factors that might contribute to aortic valve injury during radiofrequency ablation. Additionally, the course and progression of aortic regurgitation in the reported cases will be described.

Methods: Authors searched PubMed for articles using the keywords "ablation" AND "aortic insufficiency" OR "aortic valve injury" OR "aortic regurgitation". Case reports and series as well as retrospective and prospective studies were included, and relevant review articles and editorial comments were used as a supplementary source of data. A total of 19 references were used and a detailed description of patient characteristics, procedural techniques, and incidence, predictors, and fate of aortic regurgitation were reported by 11 clinical studies.

Results: There is a small risk of significant iatrogenic aortic regurgitation after radiofrequency ablation of left-sided cardiac arrhythmias, especially techniques performed via a retrograde aortic approach.

Conclusion: Although the risk is not confined to procedures applying direct energy to the aortic cusp region, a more aggressive ablation applied in the vicinity of the valvular complex seems to be associated with a higher risk. Routine post-procedural surveillance should be adopted to detect de novo aortic valve injury following radiofrequency ablation techniques.

Keywords: Aortic regurgitation; aortic insufficiency; aortic valve injury; arrhythmia; radiofrequency ablation; tachycardias..

Publication types

Review

MeSH terms

Aortic Valve Insufficiency* / etiology
Aortic Valve Insufficiency* / surgery
Catheter Ablation* / adverse effects
Humans
Prospective Studies
Retrospective Studies
Tachycardia, Supraventricular*