title: Contemporary utilization and safety outcomes of catheter ablation of atrial flutter in the United States: Analysis of 89,638 procedures.
abstract: Atrial flutter (AFL) ablation has been increasingly offered as first-line therapy and safely performed over the last decades. However, limited data exist regarding current utilization and trends in adverse outcomes arising from this procedure.
  
  
  
  The aim of our study was to examine the frequency of adverse events attributable to AFL ablation and influence of hospital volume on safety outcomes.
  
  
  
  Data were obtained from the Nationwide Inpatient Sample, the largest all-payer inpatient dataset in the United States. Patients with AFL who underwent catheter ablation from 2000 to 2011 were identified using ICD-9 codes. In-hospital death and common complications were identified, including cardiac perforation and tamponade, pneumothorax, stroke, transient ischemic attack, and vascular access complications.
  
  
  
  A total of 89,638 AFL patients were treated with catheter ablation during our study period. Total number of ablations performed increased by 154% from 2000 to 2011. The in-hospital mortality rate was 0.17% and the overall complication rate was 3.17%. Cardiac complications (1.44%) were the most frequent, followed by respiratory (0.88%), vascular (0.78%), and neurological complications (0.05%). Low hospital volume (<50 procedures/year) was significantly associated with increased adverse outcomes. Overall frequency of complications per 100 ablation procedures increased from 2.86 in 2000 to 5.39 in 2011 (P < .001).
  
  
  
  The overall complication rate was 3.17% in patients undergoing AFL ablation. There was a significant association between low hospital volume and increased adverse outcomes. This suggests a need for future research into identifying the safety measures in AFL ablations and instituting appropriate interventions to improve overall AFL ablation outcomes.
authors: University of Miami Miller School of Medicine, Miami, Florida.
authors: Nileshkumar J
authors: NJ
authors: Patel
authors: Mayo Clinic, Rochester, Minnesota.
authors: Abhishek
authors: A
authors: Deshmukh
authors: Staten Island University Hospital, Staten Island, New York.
authors: Dhaval
authors: D
authors: Pau
authors: University of Miami Miller School of Medicine, Miami, Florida.
authors: Vishal
authors: V
authors: Goyal
authors: Western Reserve Health System, Youngstown, Ohio.
authors: Samir V
authors: SV
authors: Patel
authors: Saint Peter׳s University Hospital, New Brunswick, New Jersey.
authors: Nilay
authors: N
authors: Patel
authors: Saint Peter׳s University Hospital, New Brunswick, New Jersey.
authors: Kanishk
authors: K
authors: Agnihotri
authors: Mayo Clinic, Rochester, Minnesota.
authors: Samuel
authors: S
authors: Asirvatham
authors: Mayo Clinic, Rochester, Minnesota.
authors: Peter
authors: P
authors: Noseworthy
authors: Albert Einstein College of Medicine, Bronx, New York,; Texas Cardiac Arrhythmia Institute, St. David׳s Medical Center, Austin, Texas.
authors: Luigi
authors: L
authors: Di Biase
authors: Texas Cardiac Arrhythmia Institute, St. David׳s Medical Center, Austin, Texas.
authors: Andrea
authors: A
authors: Natale
authors: University of Miami Miller School of Medicine, Miami, Florida. Electronic address: j.vilesgonzalez@med.miami.edu.
authors: Juan F
authors: JF
authors: Viles-Gonzalez
mesh_terms: D000368:Aged; D001282:Atrial Flutter / Q000401:mortality / Q000601:surgery; D002305:Cardiac Tamponade / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods; D005260:Female; D017052:Hospital Mortality; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data; D061846:Hospitals, Low-Volume / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011030:Pneumothorax / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D014481:United States / Q000453:epidemiology
keywords: Ablation; Atrial flutter; Complications; Safety; Utilization