In-Hospital Complications Associated With Catheter Ablation of Atrial Fibrillation in the United States Between 2000 and 2010

Abstract

Background-Atrial fibrillation ablation has made tremendous progress with respect to innovation, efficacy, and safety.However, limited data exist regarding the burden and trends in adverse outcomes arising from this procedure. The aim of our study was to examine the frequency of adverse events attributable to atrial fibrillation (AF) ablation and the influence of operator and hospital volume on outcomes. Methods and Results-With the use of the Nationwide Inpatient Sample, we identified AF patients treated with catheter ablation. We investigated common complications including cardiac perforation and tamponade, pneumothorax, stroke, transient ischemic attack, vascular access complications (hemorrhage/hematoma, vascular complications requiring surgical repair, and accidental arterial puncture), and in-hospital death described with AF ablation, and we defined these complications by using validated International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. An estimated 93 801 AF ablations were performed from 2000 to 2010. The overall frequency of complications was 6.29% with combined cardiac complications (2.54%) being the most frequent. Cardiac complications were followed by vascular complications (1.53%), respiratory complications (1.3%), and neurological complications (1.02%). The in-hospital mortality was 0.46%. Annual operator (<25 procedures) and hospital volume (<50 procedures) were significantly associated with adverse outcomes. There was a small (nonsignificant) rise in overall complication rates. Conclusions-The overall complication rate was 6.29% in patients undergoing AF ablation. There was a significant association between operator and hospital volume and adverse outcomes. This suggests a need for future research into identifying the safety measures in AF ablations and instituting appropriate interventions to improve overall AF ablation outcomes.

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

“…242,489,503,532,533,655,673,796,798,799,806,920,921,1202,1203,1204 More than two-thirds of the clinical trials reviewed for preparation of this document reported one or more cerebrovascular events. Thromboembolic events typically occur within 24 hours of the ablation procedure, with the high-risk period extending for the first 2 weeks following ablation.…”

“…921 Awareness about the risk of death and the possible causes might help physicians set more appropriate and efficient standards for procedural safety, and need to be considered in the patient’s decision-making process.…”

Ablation of Atrial Fibrillation

“…Data have consistently shown 107,108 that procedural outcomes improve with center experience. U.S. registry data from over 93,000 patients in the U.S. national inpatient sample database 5 showed an in-hospital mortality rate of 0.42%, and an overall complication rate of 6.29% (figure 4) that were lower in high volume centers. The possibility that complication rates are trending higher in some studies 5 , although not others [107][108][109][110] , may reflect treatment of more complex, older patients with persistent AF 111 in whom widespread ablation and long procedure times may cause complications.…”

“…The use of ablation has been encouraged by the disappointing results of important trials that question both pillars of pharmacological therapy -to strictly control ventricular rate 2 or to maintain sinus rhythm 3,4 . Buoyed by the success of ablation for 'simple' supraventricular and ventricular arrhythmias, ablation is increasingly used for AF 5 and is superior to pharmacological therapy for patients with early (paroxysmal) 6,7 to advanced (persistent) AF 8 . Nevertheless, fibrillation is a complex disease and the overall success of ablation remains lower 9 for AF than for other arrhythmias 6, 7, 10-13 -despite remarkable successes in individual patients.…”

Plasma MicroRNAs Relate to Atrial Fibrillation Recurrence after Catheter Ablation: Longitudinal Findings from the MiRhythm Study

“…Catheter ablation (CA) of AF is commonly employed to reduce arrhythmia burden, manage symptoms, and improve AF-specific quality of life [2]. Although CA is highly effective in some patients, AF recurrence after ablation occurs in up to 65% of patients undergoing this procedure within 1 year [2].…”