Factors impacting complication rates for catheter ablation of atrial fibrillation from 2003 to 2015.
Complications from catheter ablation for atrial fibrillation (AF) are well described. Changing aspects of AF ablation including patient populations referred, institutional experience, and emerging catheter and pharmacological options may impact complication rates. We assessed procedural complication trends in AF ablation patients from 2003–2015 to identify what factors affect adverse event rates.



We evaluated consecutively enrolled patients undergoing initial AF ablation from 2003 through 2015. Statistical analyses were performed to identify predictors of increased risk for major complications, which were defined as death, stroke, atrio-oesophageal fistula, phrenic nerve injury, cardiovascular events requiring blood transfusions or procedural interventions, or non-cardiovascular events requiring intervention. A total of 1475 patients (mean age 59.5 ± 10.5, 82% male) were evaluated. Major complications occurred in 3.9% (n = 58) of cases, including vascular access-site haematoma (1.3%), cardiac tamponade (1.1%), and cerebrovascular accident (CVA) (0.9%). Univariate analysis revealed increased risk of complications associated with hypertension (P = 0.048), CHA2DS2VASc score ≥1 (P = 0.015), and early institutional experience (P = 0.003). Populations with higher CHA2DS2VASc scores underwent AF ablation more frequently over time (P < 0.001). Novel catheters and anticoagulants did not appreciably affect complication rates. Multivariate analysis adjusting for hypertension, CHA2DS2VASc score, and institutional experience showed that higher CHA2DS2VASc score and early institutional experience were independent predictors of adverse events.



Patient characteristics reflected in CHA2DS2VASc scoring and early institutional experience predict increased complication rates following AF ablation. Despite more patients with higher CHA2DS2VASc scores undergoing AF ablation, complication rates fell over time as institutional experience increased.
Department of General Internal Medicine, Johns Hopkins Hospital, Baltimore, MD, USA.
Eunice
E
Yang
Johns Hopkins Hospital Heart and Vascular Institute, Johns Hopkins Hospital, Baltimore, MD, USA.
Esra Gucuk
EG
Ipek
Johns Hopkins Hospital Heart and Vascular Institute, Johns Hopkins Hospital, Baltimore, MD, USA.
Muhammad
M
Balouch
Department of General Internal Medicine, Boston University Medical Center, Boston, MA, USA.
Yuliya
Y
Mints
Johns Hopkins Hospital Heart and Vascular Institute, Johns Hopkins Hospital, Baltimore, MD, USA.
Jonathan
J
Chrispin
Johns Hopkins Hospital Heart and Vascular Institute, Johns Hopkins Hospital, Baltimore, MD, USA.
Joseph E
JE
Marine
Johns Hopkins Hospital Heart and Vascular Institute, Johns Hopkins Hospital, Baltimore, MD, USA.
Ronald D
RD
Berger
Johns Hopkins Hospital Heart and Vascular Institute, Johns Hopkins Hospital, Baltimore, MD, USA.
Hiroshi
H
Ashikaga
Johns Hopkins Hospital Heart and Vascular Institute, Johns Hopkins Hospital, Baltimore, MD, USA.
Jack
J
Rickard
Johns Hopkins Hospital Heart and Vascular Institute, Johns Hopkins Hospital, Baltimore, MD, USA.
Hugh
H
Calkins
Johns Hopkins Hospital Heart and Vascular Institute, Johns Hopkins Hospital, Baltimore, MD, USA.
Saman
S
Nazarian
Johns Hopkins Hospital Heart and Vascular Institute, Johns Hopkins Hospital, Baltimore, MD, USA.
David D
DD
Spragg
D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002305:Cardiac Tamponade / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology; D017115:Catheter Ablation; D004937:Esophageal Fistula / Q000453:epidemiology*; D005260:Female; D006325:Heart Atria; D006331:Heart Diseases / Q000453:epidemiology; D006406:Hematoma / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D015999:Multivariate Analysis; D010791:Phrenic Nerve / Q000293:injuries; D011183:Postoperative Complications / Q000453:epidemiology* / Q000628:therapy; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology