title: Healthcare utilization and clinical outcomes after catheter ablation of atrial flutter.
abstract: Atrial flutter ablation is associated with a high rate of acute procedural success and symptom improvement. The relationship between ablation and other clinical outcomes has been limited to small studies primarily conducted at academic centers. We sought to determine if catheter ablation of atrial flutter is associated with reductions in healthcare utilization, atrial fibrillation, or stroke in a large, real world population. California Healthcare Cost and Utilization Project databases were used to identify patients undergoing atrial flutter ablation between 2005 and 2009. The adjusted association between atrial flutter ablation and healthcare utilization, atrial fibrillation, or stroke was investigated using Cox proportional hazards models. Among 33,004 patients with a diagnosis of atrial flutter observed for a median of 2.1 years, 2,733 (8.2%) underwent catheter ablation. Atrial flutter ablation significantly lowered the adjusted risk of inpatient hospitalization (HR 0.88, 95% CI 0.84-0.92, p<0.001), emergency department visits (HR 0.60, 95% CI 0.54-0.65, p<0.001), and overall hospital-based healthcare utilization (HR 0.94, 95% CI 0.90-0.98, p = 0.001). Atrial flutter ablation was also associated with a statistically significant 11% reduction in the adjusted hazard of atrial fibrillation (HR 0.89, 95% CI 0.81-0.97, p = 0.01). Risk of acute stroke was not significantly reduced after ablation (HR 1.09, 95% CI 0.81-1.45, p = 0.57). In a large, real world population, atrial flutter ablation was associated with significant reductions in hospital-based healthcare utilization and a reduced risk of atrial fibrillation. These findings support the early use of catheter ablation for the treatment of atrial flutter.
authors.affiliation: Department of Internal Medicine, Division of Cardiology, Electrophysiology Section, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Dewland
authors.affiliation: Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: David V
authors.initials: DV
authors.lastname: Glidden
authors.affiliation: Department of Internal Medicine, Division of Cardiology, Electrophysiology Section, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Marcus
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001282:Atrial Flutter / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000601:surgery; D017115:Catheter Ablation / Q000191:economics*; D003365:Costs and Cost Analysis; D003695:Delivery of Health Care / Q000191:economics*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012495:San Francisco / Q000453:epidemiology