In-hospital complications associated with catheter ablation of atrial fibrillation in the United States between 2000 and 2010: analysis of 93 801 procedures.
BACKGROUND
Atrial fibrillation ablation has made tremendous progress with respect to innovation, efficacy, and safety. However, limited data exist regarding the burden and trends in adverse outcomes arising from this procedure. The aim of our study was to examine the frequency of adverse events attributable to atrial fibrillation (AF) ablation and the influence of operator and hospital volume on outcomes.


RESULTS
With the use of the Nationwide Inpatient Sample, we identified AF patients treated with catheter ablation. We investigated common complications including cardiac perforation and tamponade, pneumothorax, stroke, transient ischemic attack, vascular access complications (hemorrhage/hematoma, vascular complications requiring surgical repair, and accidental arterial puncture), and in-hospital death described with AF ablation, and we defined these complications by using validated International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. An estimated 93,801 AF ablations were performed from 2000 to 2010. The overall frequency of complications was 6.29% with combined cardiac complications (2.54%) being the most frequent. Cardiac complications were followed by vascular complications (1.53%), respiratory complications (1.3%), and neurological complications (1.02%). The in-hospital mortality was 0.46%. Annual operator (<25 procedures) and hospital volume (<50 procedures) were significantly associated with adverse outcomes. There was a small (nonsignificant) rise in overall complication rates.


CONCLUSIONS
The overall complication rate was 6.29% in patients undergoing AF ablation. There was a significant association between operator and hospital volume and adverse outcomes. This suggests a need for future research into identifying the safety measures in AF ablations and instituting appropriate interventions to improve overall AF ablation outcomes.
University of Arkansas for Medical Sciences, Little Rock, AR (A.D., S.D., S.V., G.D., A.S., H.P.); Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., M.K.); Medstar Institute, Washington Hospital Center, Washington, DC (A.C.); University of Miami - Miller School Of Medicine, Miami, FL (P.G., V.S., G.T.S., A.B., R.M., J.F.V.-G.); Drexel University College of Medicine, Philadelphia, PA (K.M.); Wayne State University, Detroit, MI (T.T.); Emory University, Atlanta, GA (K.D.); and University of Kansas, Kansas City, KS (Y.M.R.).
Abhishek
A
Deshmukh
Nileshkumar J
NJ
Patel
Sadip
S
Pant
Neeraj
N
Shah
Ankit
A
Chothani
Kathan
K
Mehta
Peeyush
P
Grover
Vikas
V
Singh
Srikanth
S
Vallurupalli
Ghanshyambhai T
GT
Savani
Apurva
A
Badheka
Tushar
T
Tuliani
Kaustubh
K
Dabhadkar
George
G
Dibu
Y Madhu
YM
Reddy
Asif
A
Sewani
Marcin
M
Kowalski
Raul
R
Mitrani
Hakan
H
Paydak
Juan F
JF
Viles-Gonzalez
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000401:mortality* / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects* / Q000401:mortality*; D015897:Comorbidity; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D014481:United States / Q000453:epidemiology; D055815:Young Adult
atrial fibrillation; catheter ablation; complications