Inhospital Complications Associated With Catheter Ablation of Atrial Fibrillation in the United States Between 2000-2010: Analysis of 93,801 Procedures

Study Questions:

What are the frequency and predictors of inhospital complications of catheter ablation of atrial fibrillation (AF)?

Methods:

In this retrospective cohort study, 93,801 patients who underwent catheter ablation of AF were identified from a national administrative database of hospitalizations in 2000-2010. All complications related to the procedure were tabulated.

Results:

The majority of procedures were performed in men 50-80 years old by operators doing <25 AF ablations/year. The complication rate was 6.3%. Cardiac complications (tamponade, myocardial infarction, other iatrogenic cardiac complications) were most common (2.5%) followed by vascular (1.5%), respiratory (1.3%), and neurological (1.0%) complications. Inhospital mortality was 0.4%. Complications were more frequent among patients >80 years old, women, and patients with diabetes, renal disease, prior stroke, heart failure, vascular disease, anemia, and depression. An annual operator volume of <25 AF ablations/year was independently associated with a 49-62% higher complication rate compared to operator volume >25 cases/year. An annual hospital volume of <50 AF ablations/year was independently associated with a 33-49% higher complication rate.

Conclusions:

Inhospital complications of AF ablation occur in approximately 6% of patients undergoing AF ablation and are more likely to occur when the procedure is performed by low-volume operators or in low-volume hospitals.

Perspective:

Because the database used in this study was administrative in nature, many relevant clinical details were not available, and the data were subject to coding errors. Furthermore, no information was provided on complications that occur after the initial hospitalization, such as pulmonary vein stenosis or atrioesophageal fistula formation. Nevertheless, the finding that complications are associated with low-volume operators or hospitals is consistent with prior studies and quite plausible.

Clinical Topics: Arrhythmias and Clinical EP, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Myocardial Infarction, Hospital Mortality, Pulmonary Veins, Vascular Diseases, Catheter Ablation, Diabetes Mellitus, United States


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