Background: Attempted catheter manipulation via the retrograde aortic approach carries a risk of aortic dissection (AD) during catheter ablation.
Objective: To determine the incidence, management, and outcomes of iatrogenic AD associated with ablation of ventricular arrhythmia (VA).
Methods: All patients who sustained iatrogenic AD during retrograde aortic VA ablation at 6 centers between January 1, 2011 and September 30, 2023 were prospectively identified.
Results: Of 5925 patients who underwent ablation procedures during the study period, 18 (0.3%) developed iatrogenic AD (8 type A AD, 10 type B AD) during the procedure. The mean age was 65.4 ± 5.3 years, and 5 patients (27.8%) were female. Considerable catheter resistance was reported in all cases. Presenting symptoms included sudden-onset severe chest pain (n=13, 72.2%), back pain (n=9, 50%), abdominal pain (n=3, 16.7%), and syncope (n=3, 16.7%). Of the type A AD patients, 3 (37.5%) with antegrade dissection underwent surgical repair, and 2 (25%) with retrograde dissection were successfully managed conservatively. Three (30%) of the type B AD patients underwent endovascular intervention and 7 (70%) were managed medically. Three patients (16.7%) died; all had type A AD and died of severe hemodynamic compromise. None of the 15 survivors developed aorta-related complications during a mean follow-up of 72.7 ± 46.8 months.
Conclusion: Iatrogenic AD is a rare but potentially lethal complication of retrograde aortic VA ablation. Comprehensive measures should be taken to reduce the risk of iatrogenic AD.
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