Relationship between procedural volume and complication rates for catheter ablation of atrial fibrillation: a systematic review and meta-analysis

Abstract

Aims There are conflicting data as to the impact of procedural volume on outcomes with specific reference to the incidence of major complications after catheter ablation for atrial fibrillation. Questions regarding minimum volume requirements and whether these should be per centre or per operator remain unclear. Studies have reported divergent results. We performed a systematic review and meta-analysis of studies reporting the relationship between either operator or hospital atrial fibrillation (AF) ablation volumes and incidence of complications. Methods and results Databases were searched for studies describing the relationship between operator or hospital AF ablation volumes and incidence of complications which were published prior to 12 June 2020. Of 1593 articles identified, 14 (315 120 patients) were included in the meta-analysis. Almost two-thirds of the procedures were performed in low-volume centres. Both hospital volume of ≥50 and ≥100 procedures/year were associated with a significantly lower incidence of complications compared to <50/year (4.2% vs. 5.5%, OR = 0.58, 95% CI 0.50–0.66, P < 0.001) or <100/year (5.5% vs. 6.2%, OR = 0.62, 95% CI 0.53–0.73, P < 0.001), respectively. Hospitals performing ≥50 procedures/year demonstrated significantly lower mortality compared with those performing <50 procedures/year (0.16% vs. 0.55%, OR = 0.33, 95% CI 0.26–0.43, P < 0.001). A similar relationship existed between proceduralist volume of <50/year and incidence of complications [3.75% vs. 12.73%, P < 0.001; OR = 0.27 (0.23–0.32)]. Conclusion There is an inverse relationship between both hospital and proceduralist AF ablation volume and the incidence of complications. Implementation of minimum hospital and operator AF ablation volume standards should be considered in the context of a broader strategy to identify AF ablation Centers of Excellence.

Case volume and procedural outcomes in ablation for atrial fibrillation: Practice makes perfect?

“…The finding of a threshold in the range of 150-200 procedures per year, is in keeping with previous work suggesting benefits in excess of 100 procedures per year. 5 In addition, the present study sheds new light on the effect of ablation type on this relationship. In keeping with the recognition that cryoablation appears to offer an easier learning curve, the effect of procedural volume on both safety and efficacy outcomes was eliminated when considering only cryoablation cases.…”

“…The relationship between AF ablation volume and outcomes has been explored in previous studies. 4,5 Tonchev et al, in a meta-analysis, demonstrated a significantly lower risk of complications in centers performing >100 procedures per year (odds ratio [OR]: 0.62, 95% confidence interval [CI]: 0.53-0.73). 4 This carried over to mortality, which was significantly lower in high volume centers (OR: 0.33, 95% CI: 0.26-0.43).…”

The impact of hospital case volume on the outcomes after catheter ablation for atrial fibrillation according to the ablation technology

“…An earlier study reported that hospitals with an annual CA volume of <50 or <100 cases were significantly associated with acute complications. 14,15 Another study investigating acute complications and 30-day rehospitalization after CA for AF reported that recent hospital experience was associated with a higher risk of adverse outcomes. 7 Although the ablation technique and catheter system of these previous studies, which used data acquired before 2010, differed from those of the current study, these previous results are consistent with those of the current study, which showed that the annual case volume was inversely associated with the occurrence of acute complications.…”

“…The comparison of the impact of radiofrequency ablation versus that of cryoballoon ablation based on procedural volume was insufficient in other studies. 14,15 Some studies have shown that the cryoballoon ablation procedure is simple and safe, with a shorter procedure time than that for radiofrequency ablation. 3,24 Compared with cryoballoon ablation, radiofrequency ablation can more readily be applied to patients with persistent and long-standing AF and nonpulmonary vein triggers 12 ; however, the learning curve to develop radiofrequency ablation skills is considerable.…”

“…[7][8][9][10][11] A recent survey on AF recurrence after CA reported that the 1-year success rate off antiarrhythmic drugs was 50%−60%, 12 and another study showed that the AF recurrence rate decreased from 2005 to 2014. 13 A previous nationwide cohort study showed that a low hospital case volume (<50 or <100 procedures/year) was associated with adverse outcomes 14,15 ; however, there are few reports focusing on the casevolume effect according to the ablation technology (radiofrequency ablation or balloon ablation). Additionally, the association between the hospital case volume and AF recurrence after CA has been never reported.…”