Has Anyone had breathlessness after a cardiac ablation?

Answer 1

Yes, there are, this topic will help you out:

Complications of ablation procedures

Although complications from atrial fibrillation (AF) ablation procedures are not common they can be significant. The most concerning of these is the potential for stroke from a blood clot (thromboembolism) during the procedure. Minimizing this devastating complication requires meticulous planning. Doctors use anti-clotting drugs known as anticoagulants (i.e. warfarin) for at least four (4) weeks before the procedure, an echocardiogram evaluation (an ultrasound scan of the heart) immediately before the procedure, specific care during the procedure (minimizing the use of the catheter within the left atrium, care of the probe's sheath, and use of anticoagulant medications) and specific care after the procedure (anticoagulation until the absence of AF is proven).

Another complication is pulmonary vein stenosis. This is where the pulmonary vein reduces in diameter. Changes in ablation technique, improved catheter technology and increased operator experience have greatly reduced the risk. The current risk of pulmonary vein stenosis (of more than 50% reduction in PV diameter) is less than 2%, with most patients being asymptomatic. In a leading centre for AF ablation, out of 2000 patients having PV ablation, severe symptomatic PV stenosis (>70%) was observed in four (4) patients. Nevertheless, a screening regime is used in patients having ablation with the use of CT or MRI scans, looking for stenosis, immediately after the procedure.

Any ablation procedure can result in the creation of new conduction abnormalities. These new abnormalities may be able to support a flutter circuit - i.e., new fibrillation. After pulmonary vein isolation alone, approximately 5% present with spontaneous atrial flutter. The risk of such new arrhythmias is greater following substrate modification and accounts partly for the need for multiple procedures. Four to six (4-6) weeks following an ablation procedure, an increasing arrhythmic effect may be observed. These arrhythmias appear to be different in nature to more common arrhythmias - they rarely continue long term, and the symptoms they produce can usually be easily managed.

During the procedure, the heart itself may be pierced by the equipment - this is called a cardiac perforation. Cardiac perforation can result in cardiac tamponade, where blood accumulates around the heart and compresses it. This complication is, in general, uncommon with pulmonary vein isolation alone. However; it may be as high as 4-6% with substrate modification. In general, there are no long-term consequences if prompt drainage can be performed. Appropriate treatment centres have available facilities for such a prompt drainage available.

More recently, an accumulating number of cases have been reported of injuries outside the heart, as a result of ablation. Structures injured include the phrenic nerve, and damage to the gastric nerves resulting in digestive problems and atria-oesophageal fistula. The latter complication has resulted in a fatal outcome in some patients.


Conclusion

The last decade has seen significant developments in our understanding of atrial fibrillation (AF), and has led to the development of catheter ablation and surgical techniques that have demonstrated the real possibility of achieving a cure of AF.

Ablation limited to the pulmonary veins and nearby areas provides a success rate of approximately 70% in paroxysmal AF and 20-30% in persistent or permanent AF. These results are further improved by additional substrate modification.

For patients with persistent or permanent AF, PV isolation and substrate modification can still result in long-term freedom from AF, but generally multiple procedures are required and the complications rates are increased. Emerging evidence and technological improvements will broaden the use of these techniques in patients with AF in the future.