title: Trends and predictors of repeat catheter ablation for atrial fibrillation.
abstract: BACKGROUND
  Atrial fibrillation (AF) ablation is superior to pharmacologic therapy in achieving maintenance of normal sinus rhythm in selected patient populations. However, the procedure is resource intensive, and repeat ablations are sometimes required. We examined the predictors and trends of repeat ablation using a large national administrative claims database.
  
  
  METHODS
  Privately insured and Medicare Advantage patients who underwent catheter ablation for AF between January 1, 2004, and September 30, 2014, were included in the study. The primary outcome was repeat AF ablation during enrollment. We examined the associations between repeat ablation and patient demographics (age, gender, socioeconomic demographics), comorbid conditions (CHA2DS2-Vasc score and Charlson index), and year of the index ablation. Cox proportional hazard models were used to identify predictors of repeat ablation.
  
  
  RESULTS
  We included 8,648 adult patients in the analysis. Median age was 61.0 (interquartile range [IQR] 54-68) years, and 70.9% were men. Median follow-up was 1.1 (IQR 0.5-2.3) years. A total of 1,263 patients underwent repeat ablation (14.6%) over a total of 14,280 person-years (12.1% at 1 year). The hazard ratio (HR) for repeat ablation was higher in younger patients (HR 0.75 [0.61-0.91; P < .01] for age 65-75 and 0.55 [0.4-0.75; P < .001] for age ≥ 75 compared with age 18-54), those with higher household income (HR 1.24 [1-1.54; P < .05] for household income ≥ $100,000 compared with household income < $40,000), patients treated in the south (HR 1.15 [1-1.31]; P < .05), and those on antiarrhythmic medications (HR 1.15 [1.01-1.31]; P < .05). In particular, younger patients (ages 18-54 years) continued to undergo repeat ablations over the entire follow-up period, and the cumulative rate was approximately 40% among those followed for 5 years. Clinical characteristics including those included in the CHA2DS2-Vasc score and Charlson index did not predict likelihood of repeat ablation. The rate of repeat ablation remained constant over the available follow-up.
  
  
  CONCLUSIONS
  Approximately 1 in 8 patients treated with catheter ablation for AF will undergo a second procedure within 1 year, although the rate is as high as 40% in young patients at 5 years. The rate of repeat ablation appears to be associated with demographic characteristics (younger age and higher household income) rather than medical comorbidities.
authors.affiliation: Mayo Clinic Heart Rhythm Section, Cardiovascular Diseases, Rochester, MN.
authors.forename: Mohammed A
authors.initials: MA
authors.lastname: Al-Hijji
authors.affiliation: Mayo Clinic Heart Rhythm Section, Cardiovascular Diseases, Rochester, MN.
authors.forename: Abhishek J
authors.initials: AJ
authors.lastname: Deshmukh
authors.affiliation: Mayo Clinic Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Rochester, MN.
authors.forename: Xiaoxi
authors.initials: X
authors.lastname: Yao
authors.affiliation: Mayo Clinic Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Rochester, MN.
authors.forename: Raphael
authors.initials: R
authors.lastname: Mwangi
authors.affiliation: Mayo Clinic Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Rochester, MN.
authors.forename: Lindsey R
authors.initials: LR
authors.lastname: Sangaralingham
authors.affiliation: Mayo Clinic Heart Rhythm Section, Cardiovascular Diseases, Rochester, MN.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Friedman
authors.affiliation: Mayo Clinic Heart Rhythm Section, Cardiovascular Diseases, Rochester, MN.
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Asirvatham
authors.affiliation: Mayo Clinic Heart Rhythm Section, Cardiovascular Diseases, Rochester, MN.
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Packer
authors.affiliation: Mayo Clinic Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Rochester, MN; Optum Labs, Cambridge, MA.
authors.forename: Nilay D
authors.initials: ND
authors.lastname: Shah
authors.affiliation: Mayo Clinic Heart Rhythm Section, Cardiovascular Diseases, Rochester, MN; Mayo Clinic Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Rochester, MN. Electronic address: Noseworthy.peter@mayo.edu.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Noseworthy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult