Catheter Ablation for Cardiac Arrhythmias

Study Questions:

What is the utilization of and in-hospital complications in patients undergoing catheter ablation in the United States?

Methods:

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.

Results:

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.

Conclusions:

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.

Perspective:

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.

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

Keywords: Arrhythmias, Cardiac, Atrial Fibrillation, Atrial Flutter, Catheter Ablation, Hospital Mortality, Length of Stay, Quality Improvement, Tachycardia, Supraventricular, Tachycardia, Ventricular


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