Impact of structural heart disease on the acute complication rate in atrial fibrillation ablation: results from the German Ablation Registry.
BACKGROUND
Catheter ablation (CA) has emerged as a widespread therapeutic option in the treatment of atrial fibrillation (AF). Currently, no safety data with regard to the impact of the underlying structural heart diseases (SHD) are available. We sought to assess the risk for acute and long-term complications during CA of AF in relation to underlying SHD.


RESULTS
We included 6,211 patients in a prospective registry undergoing CA of AF in 41 nationwide centers. All patients were divided into 4 groups according to the underlying heart disease: No SHD (69.4%), hypertensive heart disease (HHD) (12.0%), coronary artery disease (CAD) (15.1%), and cardiomyopathy (CM) (3.6%). In univariate analysis, patients with HHD had an overall complication rate of 7.28%, whereas patients without an SHD had a significantly lower rate of 6.01% (P < 0.01). Multivariate analysis revealed that HHD (adjusted odds ratio [OR]: 1.97 [95% confidence interval (CI): 1.02-3.83], P = 0.0442) and age (years; OR: 1.04 [95% CI: 1.01-1.07], P = 0.0155) were independent predictors of severe, nonfatal complications and death. Other SHD including CAD (OR: 1.48 (0.73-3.00), P = 0.2797) and CM (OR: 2.37 [0.70-7.99], P = 0.1630) failed to reach statistical significance. Male sex was protective (OR: 0.47 [95% CI: 0.27-0.81], P = 0.0062).


CONCLUSIONS
In general, CA of AF has a low number of severe complications. In our prospective registry HHD emerged as an independent predictor of severe, nonfatal complications during AF ablation but other SHD including CAD and CM did not. The influence of HHD on the complication rate should be considered in patient selection.
University Heart Center, Department of Cardiology-Electrophysiology.
Boris A
BA
Hoffmann
Karl-Heinz
KH
Kuck
Dietrich
D
Andresen
Stefan G
SG
Spitzer
Ellen
E
Hoffmann
Burghard
B
Schumacher
Lars
L
Eckardt
Johannes
J
Brachmann
Rüdiger
R
Becker
Daniel
D
Steven
Thomas
T
Rostock
Claus
C
Jünger
Jochen
J
Senges
Stephan
S
Willems
D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects* / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006331:Heart Diseases / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D011446:Prospective Studies; D012042:Registries; D016896:Treatment Outcome
atrial fibrillation; cardiomyopathy; catheter ablation; complications; registry; structural heart disease