Temporal trends of in‐hospital complications associated with catheter ablation of atrial fibrillation in the United States: An update from Nationwide Inpatient Sample database (2011–2014)

Tripathi, Byomesh; Arora, Shilpkumar; Kumar, Varun; Abdel‐Rahman, Mohamed H.; Lahewala, Sopan; Dave, Maneesh; Shah, Mahek; Tan, Bryan E‐Xin; Savani, Sejal; Badheka, Apurva; Gopalan, Radha; Shantha, Ghanshyam Palamaner Subash; Viles-González, Juan F.; Deshmukh, Abhishek

doi:10.1111/jce.13471

Cited by 92 publications

(88 citation statements)

References 30 publications

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“…Over the last decade, several technological advances have largely contributed to an ever‐growing experience with the procedure, leading to improved symptom control, lower recurrence rates, and better safety profiles 8‐11 . Despite that, major complications are reported in 3.5% to 7.5% of the patients, among which cardiac, neurological, and vascular access complications are the most frequently encountered 11‐15 . Although often underreported, esophageal injury is another important and feared complication of AF ablation.…”

Section: Introductionmentioning

confidence: 99%

Esophageal injury associated with catheter ablation for atrial fibrillation: Determinants of risk and protective strategies

Assis

Shah

Narasimhan

et al. 2020

Cardiovasc electrophysiol

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Catheter ablation has become an important element in the management of atrial fibrillation. Several technical advances allowed for better safety profiles and lower recurrence rates, leading to an increasing number of ablations worldwide. Despite that, major complications are still reported, and esophageal thermal injury remains a significant concern as atrioesophageal fistula (AEF) is often fatal. Recognition of the mechanisms involved in the process of esophageal lesion formation and the identification of the main determinants of risk have set the grounds for the development and improvement of different esophageal protective strategies. More sensitive esophageal temperature monitoring, safer ablation parameters and catheters, and different energy sources appear to collectively reduce the risk of esophageal thermal injury. Adjunctive measures such as the prophylactic use of proton-pump inhibitors, as well as esophageal cooling or deviation devices, have emerged as complementary methods with variable but promising results. Nevertheless, as a multifactorial problem, no single esophageal protective measure has proven to be sufficiently effective to eliminate the risk, and further investigation is still warranted.Early screening in the patients at risk and prompt intervention in the cases of AEF are important risk modifiers and yield better outcomes. K E Y W O R D S atrial fibrillation, atrioesophageal fistula, catheter ablation, esophageal cooling, esophageal lesion, esophageal protection, esophageal thermal damage 1366 | ASSIS ET AL. SUPPORTING INFORMATIONAdditional supporting information may be found online in the Supporting Information section.How to cite this article: Assis FR, Shah R, Narasimhan B, et al.Esophageal injury associated with catheter ablation for atrial fibrillation: Determinants of risk and protective strategies.

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Section: Introductionmentioning

confidence: 99%

Esophageal injury associated with catheter ablation for atrial fibrillation: Determinants of risk and protective strategies

Assis

Shah

Narasimhan

et al. 2020

Cardiovasc electrophysiol

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“…A similar analysis in a sample of 519 951 patients from the NIS database, the Healthcare Cost and Utilization Project, and the Agency for Healthcare Research and Quality undergoing ablation of an arrhythmia in the USA between 2000 and 2013 showed that age, female sex, type of arrhythmia, Deyo modification of the Charlson comorbidity index, and low/medium hospital volume (<100 procedures/year) were independent predictors of complications . A third report investigated temporal trends of in‐hospital complications from the USA NIS database between 2011 and 2014 . Of 50 969 AF ablation procedures 2781 (5.5%) had complications.…”

Section: Discussionmentioning

confidence: 99%

Influence of risk factors in the ESC‐EHRA EORP atrial fibrillation ablation long‐term registry

Trines

Stabile

Arbelo

et al. 2019

Pacing Clinical Electrophis

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Background The influence of risk factors on atrial fibrillation (AF) ablation recurrence is increasingly recognized. We present a sub‐analysis of the European Society of Cardiology‐European Heart Rhythm Association‐European Society of Cardiology AF ablation long‐term registry on the effect of traditional risk factors for AF on postablation recurrence, reablation, and complications using real‐world data. Methods Risk factors for AF were defined as body mass index ≥27 kg/m², hypertension, chronic obstructive pulmonary disease, diabetes, alcohol ≥2 units/day, sleep apnea, smoking, no/occasional sports activity, moderate/severe mitral or aortic valve disease, any cardiomyopathy, peripheral vascular disease, chronic kidney disease, heart failure, coronary artery disease/infarction, and previous pacemaker/defibrillator implant. Patients were divided in two groups with ≥1 or without risk factors. Primary outcomes were arrhythmia recurrence after blanking period, reablation, and adverse events or death. Differences between the groups and the influence of individual risk factors were analyzed using multivariate Cox regression. Results Three thousand sixty nine patients were included; 217 patients were without risk factors. Risk factor patients were older (58.4 vs 54.1 years), more often female (32% vs 19.8%) and had more often persistent AF (27.2% vs 23.5%). In a multivariate analysis, patients without risk factors had a hazard ratio of 0.70 (95% CI 0.49‐0.99) for recurrence compared to risk factor patients. The multivariate hazard ratios for reablation or adverse events/death were not different between the two groups. Hypertension and body mass index were univariate predictors of recurrence. Conclusions Patients with ≥1 risk factor had a 30% higher risk for arrhythmia recurrence after ablation, but no differences in risk for repeat ablations and adverse events or death.

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“…In AF ablation, vascular access and bleeding remain common causes of procedural complications . These complications can lead to a prolonged hospital stay, patient discomfort, increased healthcare costs and need for additional procedures . Improved techniques for vascular access such as ultrasound can minimize chances for vascular injury, while suture techniques for venous vascular management can minimize chances for bleeding.…”

Section: Discussionmentioning

confidence: 99%

Heparin reversal with protamine sulfate is not required in atrial fibrillation ablation with suture hemostasis

Yasar

Bickel

Zhang

et al. 2019

Cardiovasc electrophysiol

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Background The utility of protamine sulfate for heparin reversal in catheter‐based atrial fibrillation (AF) ablation is unclear when using the suture closure technique for vascular hemostasis. Objective This study sought to address if protamine sulfate use for heparin reversal reduces vascular access complications in AF catheter ablation when suture techniques are used for postprocedural vascular hemostasis. Methods This is a retrospective multicenter observational study of 294 consecutive patients who underwent catheter ablation for AF with subsequent vascular access hemostasis by means of a figure‐of‐eight suture or stopcock technique. A total of 156 patients received protamine for heparin reversal before sheath removal while 138 patients did not receive protamine. The two groups were compared for procedural activated clotting time (ACT), access site complications, and duration of hospital stay. Results Baseline demographic characteristics were comparable in both groups. Despite higher ACT before venous sheath removal in patients not receiving protamine (288.0 ± 44.3 vs 153.9 ± 32.0 seconds; P < .001), there was no significant difference in groin complications, postoperative thromboembolic events, or duration of hospital stay between the two groups. Suture failure requiring manual compression was rarely observed in this cohort (0.34%). Conclusion With modern vascular access and sheath management techniques, for patients undergoing catheter ablation for AF, simple suture closure techniques can obviate the need for protamine administration to safely achieve hemostasis after removal of vascular sheaths.

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Temporal trends of in‐hospital complications associated with catheter ablation of atrial fibrillation in the United States: An update from Nationwide Inpatient Sample database (2011–2014)

Cited by 92 publications

References 30 publications

Esophageal injury associated with catheter ablation for atrial fibrillation: Determinants of risk and protective strategies

Esophageal injury associated with catheter ablation for atrial fibrillation: Determinants of risk and protective strategies

Influence of risk factors in the ESC‐EHRA EORP atrial fibrillation ablation long‐term registry

Heparin reversal with protamine sulfate is not required in atrial fibrillation ablation with suture hemostasis

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