title: Complications of catheter-based electrophysiology procedures in adults with congenital heart disease: a national analysis.
abstract: OBJECTIVE
  To determine whether adult congenital heart disease patients (ACHD) undergoing catheter-based electrophysiology (EP) procedures have an increased risk for complications compared with adults without congenital heart disease.
  
  
  METHODS
  Retrospective cohort study of a national administrative database.
  
  
  METHODS
  Nationwide Inpatient Sample, 1998 through 2011.
  
  
  METHODS
  All admission records of patients who underwent a catheter-based electrophysiology procedure, categorized based on the presence or absence of ACHD.
  
  
  METHODS
  ACHD and non-ACHD cohorts were compared with respect to baseline, procedural, and outcome characteristics.
  
  
  RESULTS
  ACHD patients accounted for n=15,133 (1.7%) of n=873,437 EP procedure admissions and comprised a significantly increasing proportion over the study period (from 0.8% in 1998 to 2.4% in 2011, p<0.0001). ACHD patients were younger than non-ACHD patients (52.5±0.3 years v 61.9±0.04 years; p<0.0001), had a longer length of stay (4.6±0.1 days v 4.4±0.01 days, p=0.013), higher total hospital charges ($89,485±$1,543 v $70,456±$175, p<0.0001), and a higher rate of procedure-related complications (odds ratio 1.66, 95% confidence interval 1.49-1.85, p<0.0001). On multivariate analysis, ACHD patients continued to demonstrate an increased risk of procedural complications (odds ratio 1.95, 95% confidence interval 1.75-2.19, p<0.0001).
  
  
  CONCLUSIONS
  ACHD patients experienced greater morbidity after catheter-based EP procedures. This finding will be of increasing significance as ACHD patients occupy a growing segment of the population undergoing these procedures. Further investigations are warranted to determine whether this increased risk is modifiable, with the aim of improving patient safety.
authors.affiliation: Departments of *Anesthesiology and Critical Care Medicine. Electronic address: bmaxwell@jhu.edu.
authors.forename: Bryan G
authors.initials: BG
authors.lastname: Maxwell
authors.affiliation: Departments of *Anesthesiology and Critical Care Medicine.
authors.forename: Jochen
authors.initials: J
authors.lastname: Steppan
authors.affiliation: Medicine, Section of Cardiac Electrophysiology, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Alan
authors.initials: A
authors.lastname: Cheng
mesh_terms: D000367:Age Factors; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000295:instrumentation*; D057785:Catheters; D015331:Cohort Studies; D016208:Databases, Factual; D004594:Electrophysiology / Q000295:instrumentation; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors
keywords: ablations; adult congenital heart disease; catheter-based procedures; electrophysiology; procedural complications