Catheter Ablation for Cardiac Arrhythmias
What is the utilization of and in-hospital complications in patients undergoing catheter ablation in the United States?
The investigators identified patients 18 years of age and older who underwent inpatient catheter ablation from 2000 to 2013 and had one primary diagnosis of any of the following arrhythmias: atrial fibrillation (AF), atrial flutter, supraventricular tachycardia, or ventricular tachycardia (VT). The authors identified the common in-hospital complications of catheter ablation by using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnosis and procedures codes. They used a two-level mixed-effects logistic regression model to identify independent predictors of complications.
An estimated total of 519,951 (95% confidence interval, 475,702-564,200) inpatient ablations were performed in the United States between 2000 and 2013. The median age was 62 years (interquartile range, 51-72 years), and 59.3% of the patients were male. The following parameters showed increasing trends during the study period: annual volume of ablations, number of hospitals performing ablations, mean age and comorbidity index of patients, rate of ≥1 complication, and length of stay (LOS) (p < 0.001 for each). Substantial proportions (27.5%) of inpatient ablation procedures were performed in low-volume hospitals and were associated with an increased risk for complications (odds ratio, 1.26; 95% confidence interval, 1.12-1.42; p < 0.001). Older age, greater numbers of comorbidities, and complex ablations for AF and VT were independent predictors of in-hospital complications and in-hospital mortality. In addition, female sex and lower hospital volumes were independent predictors of complications.
The authors concluded that from 2000 to 2013, there was a substantial increase in the annual number of in-hospital catheter ablation procedures, as well as the rate of periprocedural complications nationwide.
This study reports that the increase in comorbidities, along with an increase in the number and proportions of complex ablations (AF and VT), have resulted in higher in-hospital complication rates and longer hospital LOSs in recent years. Furthermore, many ablation procedures were performed in low-volume hospitals, which were associated with a significantly increased risk of complications. Additional studies are indicated to assess the effect of strategies such as ultrasound-guided femoral access and intracardiac echocardiography on reducing periprocedural complications and reducing LOS in patients undergoing catheter ablation procedures. Low-volume hospitals and those treating patients with greater numbers of comorbidities need to focus on targeted quality improvement to optimize outcomes.
Keywords: Arrhythmias, Cardiac, Atrial Fibrillation, Atrial Flutter, Catheter Ablation, Hospital Mortality, Length of Stay, Quality Improvement, Tachycardia, Supraventricular, Tachycardia, Ventricular
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