Radiofrequency Ablation for Atrial Fibrillation: Understanding the Risks

Radiofrequency ablation is a minimally invasive procedure commonly used to treat atrial fibrillation. During the process, doctors access the heart through deep veins such as the femoral vein, advancing to the right atrium and then crossing the interatrial septum to reach the left atrium. In this area, targeted tissue that generates abnormal electrical signals is destroyed using heat. While the procedure is effective, it comes with certain risks that patients should understand before giving consent.

Bleeding and Vascular Complications

One of the primary risks involves complications at the puncture site. Bleeding can occur, potentially leading to bruising or hematoma formation. In some cases, both the artery and vein may be accidentally punctured, resulting in an abnormal connection called an arteriovenous fistula. Because these vessels are often close together, blind punctures—guided only by touch—can increase the chance of such complications, which are difficult to fully prevent.

Cardiac Perforation and Septal Damage

Residual Holes in the Atrial Septum

Since the procedure requires puncturing the interatrial septum to access the left atrium, there is a risk that a small hole may remain afterward. This is usually minor and closes on its own over time, but in rare cases, it may require further intervention.

Atrial Perforation: A Serious Complication

Another, more severe risk is cardiac perforation. During the procedure, the thin walls of the atrium can be accidentally torn, which can lead to life-threatening conditions such as cardiac tamponade. If this occurs, immediate emergency treatment is necessary to stabilize the patient.

Esophageal Injury and Related Symptoms

The proximity of the esophagus to the treatment area presents another potential complication. Some patients may experience esophageal burns due to the heat used during ablation. This can lead to symptoms such as heartburn and acid reflux. It's important for patients to report these symptoms to their physician, as timely intervention can help manage discomfort and prevent further complications.