The rate of urgent atrial fibrillation (AFib) ablation has increased over time, and patients undergoing urgent vs. elective AFib ablation are more likely to have comorbidities like diabetes, coronary artery disease (CAD) and heart failure (HF) and have in-hospital complications, according to a recent study published in JACC: Clinical Electrophysiology.

Amneet Sandhu, MD, FACC, et al., included 140,051 patients (median age 67; 3.24% Black/African American) from 195 sites undergoing AFib ablation between January 2016 and June 2023 from the ACC's AFib Ablation Registry. The investigators explored trends in urgent ablation use and compared factors and complications associated with urgent vs. elective ablation procedures.

Overall, 2,714 (1.9%) procedures were classified as urgent. Over the course of the study period, the rate of urgent AFib ablation rose from 0.5% to 2% (p<0.0001). After adjustment, the rate of procedure-related complications was significantly higher for urgent ablation (4.9% vs. 2.4%; p<0.0001).

The authors observed higher rates of diabetes (30.6% vs. 20.4%), CAD (30.8% vs. 22.7%) and HF (47.1% vs. 20.8%; p<0.0001 for all) among urgent ablation cases vs. elective cases. Patient populations more likely to have an urgent procedure included Black individuals (odds ratio [OR] 1.68; 95% CI 1.41-2.0) and those presenting to the procedure in AFib (OR 1.73; 95% CI 1.36-2.20). Additionally, higher hospital volume for AFib ablation was associated with greater odds of urgent ablation (OR [per 100 cases] 1.22; 95% CI 1.20-1.25).

The authors note that the steady increase in urgent ablation accelerated following the publication and dissemination of the CASTLE-AF trial, "which demonstrated a survival benefit of catheter ablation for [AFib] patients with HF."

"Despite higher aggregate risk-adjusted complication rates associated with urgent [AFib] ablation, the decision to pursue [AFib] ablation remains nuanced with potential important clinical value, though warranting careful risk-benefit evaluation," they write.