Procedural Complications, Rehospitalizations, and Repeat Procedures After Catheter Ablation for Atrial Fibrillation
What are the rates of complications and redo procedures in unselected patients undergoing catheter ablation of atrial fibrillation (AF) in a community setting?
Discharge diagnoses and procedure codes in the California State Inpatient Database were analyzed to identify patients who underwent ablation of AF in 2005-2008. Information on comorbidities was obtained by reviewing secondary diagnosis codes. The other data collected consisted of the number of AF hospitalizations, acute procedural complications, all-cause rehospitalizations, and long-term rehospitalizations for AF or for redo ablation.
AF ablation was performed in 4,156 patients (mean age 61.7 years). The rate of acute complications was 5.1%, most commonly vascular complications, perforation/tamponade, and hematoma/hemorrhage. The rate of rehospitalization at 30 days was 9.4%, most commonly for AF/flutter or a procedural complication. Mortality at 30 days was 0.24%. The independent predictors of complications and/or 30-day rehospitalizations were age, female gender, and the number of AF hospitalizations during the prior year. The median follow-up was 1.5 years. The redo ablation rate was 17.4%. At 2 years, 70% of patients were free of rehospitalization for AF or redo ablation.
The authors concluded that the periprocedural complication rate in unselected patients undergoing catheter ablation of AF is 5.1%, and the redo ablation rate is 17.4%.
The strengths of this study are the large sample size and the unselected nature of the patient population. But because only inpatient diagnosis and procedure codes were available for review, the efficacy of AF ablation could not be determined and the complication rate most likely was underestimated. Because not all patients with recurrent AF undergo redo ablation, it is very likely that the rate of recurrent AF/flutter exceeded 17.4%.
Keywords: Follow-Up Studies, Clinical Coding, California, Pulmonary Veins, Comorbidity, Hematoma, Inpatients, Catheter Ablation
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