Published online Jun 26, 2020. doi: 10.4330/wjc.v12.i6.269
Peer-review started: February 26, 2020
First decision: April 25, 2020
Revised: May 3, 2020
Accepted: May 26, 2020
Article in press: May 26, 2020
Published online: June 26, 2020
Processing time: 121 Days and 5.8 Hours
Cardiac catheterization is among the most performed medical procedures in the modern era. There were sporadic reports indicating that cardiac arrhythmias are common during cardiac catheterization, and there are risks of developing serious and potentially life-threatening arrhythmias, such as sustained ventricular tachycardia (VT), ventricular fibrillation (VF) and high-grade conduction disturbances such as complete heart block (CHB), requiring immediate interventions. However, there is lack of systematic overview of these conditions.
To systematically review existing literature and gain better understanding of the incidence of cardiac arrhythmias during cardiac catheterization, and their impact on outcomes, as well as potential approaches to minimize this risk.
We applied a combination of terms potentially used in reports describing various cardiac arrhythmias during common cardiac catheterization procedures to systematically search PubMed, EMBASE and Cochrane databases, as well as references of full-length articles.
During right heart catheterization (RHC), the incidence of atrial arrhythmias (premature atrial complexes, atrial fibrillation and flutter) was low (< 1%); these arrhythmias were usually transient and self-limited. RHC associated with the development of a new RBBB at a rate of 0.1%-0.3% in individuals with normal conduction system but up to 6.3% in individuals with pre-existing left bundle branch block. These patients may require temporary pacing due to transient CHB. Isolated premature ventricular complexes or non-sustained VT are common during RHC (up to 20% of cases). Sustained ventricular arrhythmias (VT and/or VF) requiring either withdrawal of catheter or cardioversion occurred infrequently (1%-1.3%). During left heart catheterizations (LHC), the incidence of ventricular arrhythmias has declined significantly over the last few decades, from 1.1% historically to 0.1% currently. The overall reported rate of VT/VF in diagnostic LHC and coronary angiography is 0.8%. The risk of VT/VF was higher during percutaneous coronary interventions for stable coronary artery disease (1.1%) and even higher for patients with acute myocardial infarctions (4.1%-4.3%). Intravenous adenosine and papaverine bolus for fractional flow reserve measurement, as well as intracoronary imaging using optical coherence tomography have been reported to induce VF. Although uncommon, LHC and coronary angiography were also reported to induce conduction disturbances including CHB.
Cardiac arrhythmias are common and potentially serious complications of cardiac catheterization procedures, and it demands constant vigilance and readiness to intervene during procedures.
Core tip: Cardiac catheterization is the most performed invasive procedure in the current healthcare system. Cardiac arrhythmias are common complications during the procedure. This review demonstrated a 0.14%-0.3% incidence of transient right bundle branch block during right heart catheterization in normal individuals, and a significantly higher risk of complete heart block (up to 6.3%) for individuals with pre-existing left bundle brunch block. Potentially life-threatening ventricular arrhythmias requiring either withdrawal of catheter or cardioversion could occur at the rates of 1%-1.3%. The incidence of significant arrhythmias during left heart catheterization has reduced by about 10 folds in the past half century, from 1.1% to 0.1%. Coronary interventions, as well as intracoronary imaging and measuring fractional flow reserve, carry increased risk of malignant arrhythmias, including up to 1% incidence of ventricular fibrillations. Constant telemetry monitoring is essential during cardiac catheterization.