Systematic Reviews
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Jun 26, 2020; 12(6): 269-284
Published online Jun 26, 2020. doi: 10.4330/wjc.v12.i6.269
Intra-procedural arrhythmia during cardiac catheterization: A systematic review of literature
Fatima A Shaik, David J Slotwiner, Gregory M Gustafson, Xuming Dai
Fatima A Shaik, David J Slotwiner, Gregory M Gustafson, Xuming Dai, Division of Cardiology, New York Presbyterian Queens Hospital, Flushing, NY 11355, United States
Author contributions: Shaik FA participated in the development of the proposal to research on the topic, performed literature search and review, and wrote the draft of the manuscript, reviewed, edited and approved the manuscript; Slotwiner DJ participated in the supervision of the research on the topic, reviewed and edited the manuscript. Gustafson GM participated in the research on the topic, reviewed, edited and approved the manuscript; Dai X initiated and supervised the research on this topic, originated the manuscript concept, participated in literature search and review, wrote and revised the manuscript as a senior author.
Conflict-of-interest statement: Authors declare no potential conflicts of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared, revised and presented according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Xuming Dai, MD, PhD, FACC, FSCAI, Associate Professor, Division of Cardiology, New York Presbyterian Queens Hospital, 56-45 Main Street, Flushing, NY 11355, United States. xud9002@nyp.org
Received: February 26, 2020
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
ARTICLE HIGHLIGHTS
Research background

Cardiac Catheterization is one of the most commonly performed procedures in the modern health care system. Given the nature of intracardiac and intracoronary manipulation of catheters during the procedure, arrhythmias are common, and potentially consequential. Understanding the incidence, risk factors and strategies to mitigate the risk bears clinical significance.

Research motivation

There are sporadic reports on the topics of intra-procedural arrhythmias during cardiac catheterization. We systematically reviewed published literature, analyzed the incidence rate, temporary trends, and predictors of atrial and ventricular arrhythmias during left and right heart cardiac catheterization. We also discussed factors and approaches to reduce arrhythmias and improve the safety of the procedures.

Research objectives

The goal of this study is to provide a comprehensive overview of the incidence rates and impact on short- and long-term outcomes of arrhythmias during cardiac catheterization, as well as understand approaches to minimize the risk of malignant arrhythmias during cardiac catheterization.

Research methods

We systematically searched PubMed, EMBASE and Cochrane databases with a combination of comprehensive terms related to cardiac catheterization procedures and various cardiac arrhythmias, then carefully reviewed and synthesized the data by types of procedure and arrhythmias.

Research results

We found a 0.14-0.3% incidence of transient right bundle branch block during right heart catheterization (RHC) in normal individuals, and a significantly higher risk of complete heart block (up to 6.3%) requiring temporary or permanent pacing for individuals with pre-existing left bundle branch block (LBBB). Isolated premature ventricular contraction or non-sustained ventricular tachycardia (VT) which do not require specific treatment are common (approximately 20% incidence rate) during RHC. Potentially life-threatening ventricular arrhythmias (sustained VT and/or ventricular fibrillation) requiring either withdrawal of catheter or cardioversion also occur but at lower rates (1.0%-1.3%). The incidence rate of diagnostic left heart catheterization and coronary angiography causing arrhythmias has significantly reduced from 1.1% to 0.1% in the last half century. However, invasive coronary intervention and hemodynamic assessment including optical computed tomography and fractional flow reserve continue to possess a significantly higher risk.

Research conclusions

Cardiac arrhythmias are common during cardiac catheterization. While the majority of arrhythmias are benign and self-limited, complete heart block in the presence of pre-existing LBBB and ventricular tachycardia during RHC could be consequential requiring interventions. As the improvement of reagents, equipment and techniques, the incidence rate of serious arrhythmias such as ventricular tachycardia/fibrillation during LHC has significantly decreased, but it continues to require constant intra-procedural monitoring and readiness to intervene.

Research perspectives

As cardiac catheterization procedure continues to serve as essential diagnostic and therapeutic tool for patients, intra-procedural cardiac arrhythmias occur at relatively low incidence rates. Understanding the types of arrhythmias, associated risk factors and the strategies to monitor and mitigate the risk continue to be essential for patient safety and procedure success. It continues to require close surveillance and exploration of best practice to minimize the risk.