Abstract 19671: Contemporary Patterns of Utilization and Safety Outcomes of Catheter Ablation of Atrial Flutter in the United States

Introduction: Atrial flutter ablation has been increasingly offered as first line therapy and has been safely performed over the past few decades. However, limited data exists 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 atrial flutter (AFL) ablation and the influence of hospital volume on safety outcomes. Hypothesis: We hypothesize an association between hospital volume and adverse outcomes. Methods: With the use of the Nationwide Inpatient Sample, we identified 89,638 AFL patients treated with catheter ablation from 2000-2011. We investigated common complications including cardiac perforation and tamponade, pneumothorax, stroke, transient ischemic attack, vascular access complications, and in-hospital death. We defined these complications by using validated International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. Results: The overall frequency of complications was 3.17%, with combined cardiac complications (1.44%) being the most frequent. Cardiac complications were followed by vascular complications (0.78%), respiratory complications (0.88%), and neurological complications (0.05%). The in-hospital mortality was 0.17%. Low hospital volume (<50 procedures) was significantly associated with increased adverse outcomes. In addition, there was a small, insignificant rise in overall complication rates over time. Conclusions: 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.

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Contemporary utilization and safety outcomes of catheter ablation of atrial flutter in the United States: Analysis of 89,638 procedures

Heart Rhythm ◽

10.1016/j.hrthm.2016.02.005 ◽

2016 ◽

Vol 13 (6) ◽

pp. 1317-1325 ◽

Cited By ~ 22

Author(s):

Nileshkumar J. Patel ◽

Abhishek Deshmukh ◽

Dhaval Pau ◽

Vishal Goyal ◽

Samir V. Patel ◽

...

Keyword(s):

United States ◽

Catheter Ablation ◽

Atrial Flutter ◽

The United States ◽

Safety Outcomes

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Practice Patterns and Real-Life Outcomes for Patients with Acute Promyelocytic Leukemia in the United States

Blood Advances ◽

10.1182/bloodadvances.2021005642 ◽

2021 ◽

Author(s):

Jan Philipp Bewersdorf ◽

Stephanie Prozora ◽

Nikolai A. Podoltsev ◽

Rory Michael Shallis ◽

Scott F Huntington ◽

...

Keyword(s):

Acute Promyelocytic Leukemia ◽

Adverse Outcome ◽

Real Life ◽

The United States ◽

Population Based ◽

Promyelocytic Leukemia ◽

Adverse Outcomes ◽

Hospital Death ◽

Newly Diagnosed ◽

Logistic Regression Models

Acute promyelocytic leukemia (APL) is associated with a favorable long-term prognosis if appropriate treatment is initiated promptly. Outcomes in clinical trials and population-based registries vary; potential explanations include a delay in treatment and lower adherence to guideline-recommended therapy in real-world practice. We used the Vizient Clinical Data Base (CDB) to describe demographics, baseline clinical characteristics, and treatment patterns in newly diagnosed APL patients during the study period of April 2017 - March 2020. Baseline white blood cell count (WBC) was used to assign risk status and assess treatment concordance with National Comprehensive Cancer Network guidelines. Logistic regression models examined adjusted associations between patient, hospital, disease characteristics, and adverse outcomes (in-hospital death or discharge to hospice). Among 1,464 APL patients, 205 (14.0%) experienced an adverse outcome. A substantial subset (20.6%) of patients did not receive guideline-concordant regimens. Odds of adverse outcomes increased with failure to receive guideline-concordant treatment (OR: 2.31 [95% CI: 1.43 - 3.75]; p=0.001), high-risk disease (OR: 2.48 [1.53 - 4.00]; p<0.001) and increasing age (≥60 years: OR: 11.13 [95% CI: 4.55 - 27.22]; p<0.001). Higher hospital AML patient volume was associated with lower odds of adverse outcome (OR: 0.44 [0.20 - 0.99] for ≤ 50 vs. >200 AML patients/year; p=0.046). In conclusion, in this large database analysis, 14.0% of newly diagnosed APL patients died or were discharged to hospice. A substantial proportion of patients did not receive guideline-concordant therapy, potentially contributing to adverse outcomes.

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P6510Frailty and in-hospital outcomes in percutaneous coronary interventions

European Heart Journal ◽

10.1093/eurheartj/ehz746.1100 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

C S Kwok ◽

S Achenbach ◽

N Curzen ◽

D L Fischman ◽

M Savage ◽

...

Keyword(s):

Average Length ◽

Vascular Complications ◽

Coronary Intervention ◽

Adverse Outcomes ◽

Bleeding Complications ◽

Inpatient Cost ◽

Hospital Death ◽

Percutaneous Coronary ◽

Poor Outcomes ◽

Over Time

Abstract Background Frailty may be an important marker for poor outcomes in percutaneous coronary intervention (PCI) and there is limited literature on outcomes based on frailty from national cohorts. Purpose This study evaluates the prevalence of frailty, changes in frailty over time and outcomes associated with frailty in a national American cohort of patients who underwent PCI. Methods The study included adults who underwent PCI in the National Inpatients Sample between 2004 and 2014. Frailty risk was determined using a validated Hospital Frailty Risk Score (HFRS) using the cutoffs <5, 5–15 and >15 corresponding to low, intermediate and high HFRS. Results There were 7,306,007 PCI admissions in this cohort. A total of 94.58%, 5.39% and 0.03% of admissions were for low HFRS, intermediate HFRS and high HFRS, respectively. The proportion of intermediate or high frailty risk patients increased over time from 1.9% in 2004 to 11.7% in 2014. In-hospital death increased from 1.0% with low HFRS to 13.9% with high HFRS and average length of stay increased from 2.9±3.3 days to 17.1±15.5 days from low to high HFRS. Greater frailty risk was associated with greater average inpatient cost which was $17,743±11,059, $38,824±34,809 and $56,119±49,772 for low, intermediate and high HFRS, respectively. There were increased adverse outcomes with high frailty including greater in-hospital death (OR 9.91 95% CI 7.17–13.71), in-hospital bleeding complications (OR 4.99 95% CI 3.82–6.51), in-hospital vascular complications (OR 3.96 95% CI 3.00–5.23) and in-hospital stroke (OR 10.49 95% CI 8.28–13.29) comparing high to low HFRS. Conclusions More than 1 in 20 patients who undergo PCI have intermediate or high risk of frailty which has significantly increased over time. There are poor outcomes and increased inpatient costs associated with greater frailty. Improvements in education of healthcare workers and increased awareness of frailty could facilitate frailty-tailored care to minimise risk of adverse outcomes and its associated costs. Acknowledgement/Funding Research and Development Department at the Royal Stoke Hospital, Keele University and Biosensors International

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Complication rates following ventricular tachycardia ablation in ischaemic and non-ischaemic cardiomyopathies: a systematic review

Journal of Interventional Cardiac Electrophysiology ◽

10.1007/s10840-021-00948-6 ◽

2021 ◽

Author(s):

Wern Yew Ding ◽

Charles M. Pearman ◽

Laura Bonnett ◽

Ahmed Adlan ◽

Shui Hao Chin ◽

...

Keyword(s):

Ventricular Tachycardia ◽

Catheter Ablation ◽

Vascular Complications ◽

Major Complication ◽

Complication Rates ◽

Ventricular Tachycardia Ablation ◽

Ischaemic Cardiomyopathy ◽

Cerebrovascular Events ◽

Acute Complications ◽

Vt Ablation

Abstract Background Catheter ablation of ventricular tachycardia (VT) is associated with potential major complications, including mortality. The risk of acute complications in patients with ischaemic cardiomyopathy (ICM) and non-ischaemic cardiomyopathy (NICM) has not been systematically evaluated. Methods PubMed was searched for studies of catheter ablation of VT published between September 2009 and September 2019. Pre-specified primary outcomes were (1) rate of major acute complications, including death, and (2) mortality rate. Results A total of 7395 references were evaluated for relevance. From this, 50 studies with a total of 3833 patients undergoing 4319 VT ablation procedures fulfilled the inclusion criteria (mean age 59 years; male 82%; 2363 [62%] ICM; 1470 [38%] NICM). The overall major complication rate in ICM cohorts was 9.4% (95% CI, 8.1–10.7) and NICM cohorts was 7.1% (95% CI, 6.0–8.3). Reported complication rates were highly variable between studies (ICM I2 = 90%; NICM I2 = 89%). Vascular complications (ICM 2.5% [95% CI, 1.9–3.1]; NICM 1.2% [95% CI, 0.7–1.7]) and cerebrovascular events (ICM 0.5% [95% CI, 0.2–0.7]; NICM, 0.1% [95% CI, 0–0.2]) were significantly higher in ICM cohorts. Acute mortality rates in the ICM and NICM cohorts were low (ICM 0.9% [95% CI, 0.5–1.3]; NICM 0.6% [95% CI, 0.3–1.0]) with the majority of overall deaths (ICM 75%; NICM 80%) due to either recurrent VT or cardiogenic shock. Conclusion Overall acute complication rates of VT ablation are comparable between ICM and NICM patients. However, the pattern and predictors of complications vary depending on the underlying cardiomyopathy.

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CERVICAL SPONDYLOTIC MYELOPATHY

Neurosurgery ◽

10.1227/01.neu.0000316013.97926.4c ◽

2008 ◽

Vol 62 (2) ◽

pp. 455-462 ◽

Cited By ~ 106

Author(s):

Maxwell Boakye ◽

Chirag G. Patil ◽

Justin Santarelli ◽

Chris Ho ◽

Wendy Tian ◽

...

Keyword(s):

United States ◽

Multivariate Analysis ◽

Length Of Stay ◽

Spinal Fusion ◽

Cervical Spondylotic Myelopathy ◽

Adverse Outcome ◽

The United States ◽

Adverse Outcomes ◽

Medical Complications ◽

Complication Rates

Abstract OBJECTIVE There is little information about in-hospital complication rates, adverse outcomes, and mortality after spinal fusion for cervical spondylotic myelopathy (CSM). The aim of this study was to report inpatient mortality, complications, and outcomes on a national level. METHODS We used the National Inpatient Sample to identify 58,115 admissions of patients with CSM who underwent spinal fusion in the United States from 1993 to 2002. Multivariate analysis was performed to analyze the effects of patient and hospital characteristics on outcomes such as mortality, complications, discharge disposition, and length of stay. RESULTS A total of 58,115 patients with CSM underwent spinal fusion with an average mortality rate of 0.6%, a complication rate of 13.4%, and a mean length of stay of 4 days. Pulmonary (3.6%) and postoperative hemorrhages or hematomas (2.3%) were the most common complications reported. One postoperative complication led to a 4-day increase in mean length of stay, increased the mortality rate 20-fold, and added more than $10,000 to hospital charges. Multivariate analysis identified age, comorbidity, and admission type as the main predictors of mortality, complication rate, and adverse outcome. Patients aged ≥85 or 65 to 84 years had respective 44- and 14-fold increases in mortality, compared with patients in the 18- to 44-year age group. Patients older than 84 years had a 40-fold increase in adverse outcomes and a 5-fold likelihood of medical complications. Patients with three or more comorbidities had an increased risk of medical complications (odds ratio [OR], 1.98), adverse discharge (OR, 2.17), and in-hospital mortality (OR, 2.36). Elective admissions were associated with much lower rates of mortality (OR, 0.28), complication (OR, 0.68), and adverse outcome (OR, 0.26). Complications were greater for posterior fusion (16.4%) versus anterior fusion (11.9%) procedures. Anterior fusions were associated with a greater incidence of dysphagia (3%) and hoarseness (0.21%). Cervical spondylosis patients who presented without myelopathy had a much lower incidence of complications (6.3%). CONCLUSIONS We provide a national estimate of inpatient complications and outcomes after spinal fusion for CSM patients in the United States. We demonstrate the impacts of age, complications, and medical comorbidities on the outcome of surgery for patients with this common disorder. We provide complication rates stratified by age and medical comorbidities for elderly patients who present with CSM who need spinal fusion.

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Abstract 15958: Comparison of In-hospital Outcomes of Patients Undergoing Catheter Ablation for Typical versus Atypical Atrial Flutter

Circulation ◽

10.1161/circ.142.suppl_3.15958 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Bertrand Ebner ◽

Jennifer Maning ◽

Jelani Grant ◽

Louis Vincent ◽

Odunayo P Olorunfemi ◽

...

Keyword(s):

Cohort Study ◽

Catheter Ablation ◽

Atrial Flutter ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Hospital Charges ◽

Complication Rates ◽

Hospital Outcomes ◽

Coronary Syndrome ◽

Definitive Therapy

Introduction: Catheter Ablation (CA) is indicated as definitive therapy for patients with atrial flutter (AF) which is unresponsive to medical therapy. While atrial flutter may be typical (TAF) or atypical (AAF), there is a paucity of data regarding in-hospital outcomes of patients undergoing CA. Methods: This retrospective cohort study used the Nationwide Inpatient Sample to identify all patients above 18 years who underwent CA between 2015 and 2017. Individuals were identified using ICD-10-CM/PCS for TAF, AAF and CA. Statistical analysis was performed comparing TAF to AAF. Results: A total of 17,390 patients underwent CA for AF, with 33% having AAF and 67% TAF. Patients with TAF were younger (median 67 years vs. 68 years), with lower proportion of females (29.6% vs. 42.8% p≤0.05 for both) compared to patients with AAF. TAF group had higher rates of emergent admission (85.7% vs. 65.5% p≤0.05). Interestingly, subjects with AAF had earlier interventions than patients with TAF (≤3 days of admission, 76.4% vs. 71% p≤0.05). Patients with TAF have a higher rate of hypertension, diabetes, smoking, heart failure, liver disease, and chronic obstructive pulmonary disease (p≤0.05 for all). However, patients with AAF had increased prior strokes and percutaneous coronary interventions (PCI) (p≤0.05 for both). The mean CHA2DS2-VASc score was found to be 2.3 in AAF compared to 2.1 in TAF (controlled for comorbidities, p≤0.05). Multivariable regression showed a significantly higher proportion of cardiogenic shock, acute coronary syndrome, sepsis, cardiac catheterization, PCI, thromboembolism event, transfusion, and longer length of stay in patients with TAF (p≤0.05 for all). Although we found that patients with AAF have significant higher rates of cardioversion, implantation of cardiac device, pericardial complications, and increased hospital charges (p≤0.05 for all), no significant difference was found in mortality. Conclusion: In this retrospective cohort study, we found higher complication rates in CA of patients with TAF, even when adjusting for pertinent comorbidities, but no difference in in-hospital all-cause mortality. Variation in CA depending upon the mechanism of AF may underlie these differences, and warrant further study.

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Abstract 072: Impact of Chronic Diabetes on Periprocedural Outcomes Among Patient With Atrial Fibrillation and Flutter Who Underwent Radiofrequency Catheter Ablation Therapy (RFA). Report From the NIS 2014.

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.10.suppl_3.072 ◽

2017 ◽

Vol 10 (suppl_3) ◽

Author(s):

Samson E Alliu ◽

Adeyinka Adejumo ◽

Modupeolowa Durojaiye ◽

Akintoye Emmanuel ◽

Lawrence Wolf ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Perioperative Complications ◽

Vascular Complications ◽

Cardiac Complications ◽

Peripheral Vascular ◽

Respiratory Complications ◽

Ablation Therapy ◽

Teaching Status ◽

Atrial Fibrillation And Flutter

Background: Diabetes has been associated with complications and poor perioperative outcomes. In Radiofrequency catheter ablation - therapy of choice for drug refractory atrial fibrillation and flutter, association between diabetes and procedural complications are less documented. Objectives: To examine if there is a difference in perioperative complications in patients with chronic diabetes who underwent RFA for atrial fibrillation/flutter when compared with non-diabetics. Methods: We selected patients > 45 years from the National Inpatient Survey data 2014. We identified 8356 patients (69.6 ± 9.1yrs) who underwent catheter ablation. Logistic regression analyses were performed to investigate the difference in perioperative complications (hemorrhage, cardiac perforation, cardiac complications, respiratory complications, peripheral vascular complications, stroke and in-hospital mortality) between diabetics and non-diabetics. All models were adjusted for age, gender, race, residential income, insurance, co-morbidities, hospital bed size, hospital location/teaching status, hospital region, length of stay and median household income. Results: Among our selected 8356 patients, 5777(69.1%) were non-diabetics, 2203(26.4%) had uncomplicated diabetes and 376 (4.5%) complicated diabetes. Overall there were 634 events (240 hemorrhages, 56 perforations, 163 cardiac complications, 43 respiratory complications, 12 strokes, 40 peripheral vascular complications and 80 in-hospital death. Rates of complications were the same among diabetes and non-diabetics. In the multivariate models, the odds of complications remain statistically non-significant across all the groups. However, among all the patients who underwent RFA, there is an increased odds of hemorrhage among patients with Medicare insurance versus private insurance (OR 1.73 95%CI 1.11-2.70), peripheral vascular complications among hospitals in the south (OR 3.35 95%CI 1.30-9.62), respiratory complications among patients with CHF (4.60 95%CI 1.68-12.60), death among patients with renal failure (OR 2.22 95%CI 1.32-3.73) and hospitals in the south (2.55 95% CI 1.08-6.0) and west (OR 3.23 95%CI 1.25-8.3) compared to the northeast. Odds of stroke were less among both urban non-teaching (OR 0.02 95%CI 0.01 - 0.34) and teaching hospital (OR 0.05 95%CI 0.01-0.36) when compared to rural hospital. Conclusions: RFA has a similar procedural safety in diabetics when compared to non-diabetic patients. It remains a safe procedure in diabetics with drug-refractory atrial fibrillation and flutter. Renal failure, CHF, type of Insurance, hospital location and teaching status are predictors of complications after RFA.

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SARS-CoV-2 Cardiac Involvement in Young Competitive Athletes

Circulation ◽

10.1161/circulationaha.121.054824 ◽

2021 ◽

Author(s):

Nathaniel Moulson ◽

Bradley J. Petek ◽

Jonathan A. Drezner ◽

Kimberly G. Harmon ◽

Stephanie A. Kliethermes ◽

...

Keyword(s):

Cardiac Involvement ◽

Diagnostic Yield ◽

Collegiate Athletes ◽

The United States ◽

Adverse Outcomes ◽

Cardiac Complications ◽

Primary Screening ◽

Competitive Athletes ◽

Clinical Surveillance

Background: Cardiac involvement among hospitalized patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is common and associated with adverse outcomes. The objective of this study was to determine the prevalence and clinical implications of SARS-CoV-2 cardiac involvement in young competitive athletes. Methods: In this prospective multicenter observational cohort study with data from 42 colleges/universities, we assessed the prevalence, clinical characteristics, and outcomes of SARS-CoV-2 cardiac involvement among collegiate athletes in the United States. Data were collected from September 1, 2020 to December 31, 2020. The primary outcome was the prevalence of definite, probable, or possible SARS-CoV-2 cardiac involvement based on imaging definitions adapted from the Updated Lake Louise Criteria. Secondary outcomes included the diagnostic yield of cardiac testing, predictors for cardiac involvement, and adverse cardiovascular events or hospitalizations. Results: Among 19,378 athletes tested for SARS-CoV-2 infection, 3018 (mean age 20 years [SD,1 year]; 32% female) tested positive and underwent cardiac evaluation. A total of 2820 athletes underwent at least one element of cardiac 'triad' testing [12-lead electrocardiography (ECG), troponin, and/or transthoracic echocardiography(TTE)] followed by cardiac magnetic resonance (CMR) if clinically indicated. In contrast, primary screening CMR was performed in 198 athletes. Abnormal findings suggestive of SARS-CoV-2 cardiac involvement were detected by ECG (21/2999,0.7%), cardiac troponin (24/2719,0.9%), and TTE (24/2556,0.9%). Definite, probable, or possible SARS-COV-2 cardiac involvement was identified in 21/3018 (0.7%) athletes, including 15/2820 (0.5%) who underwent clinically indicated CMR (n=119) and 6/198 (3.0%) who underwent primary screening CMR. Accordingly, the diagnostic yield of CMR for SARS-COV-2 cardiac involvement was 4.2 times higher for a clinically indicated CMR (15/119,12.6%) versus a primary screening CMR (6/198,3.0%). After adjustment for race and sex, predictors of SARS-CoV-2 cardiac involvement included cardiopulmonary symptoms (OR:3.1,95% CI:1.2,7.7) or at least one abnormal triad test (OR:37.4,95% CI:13.3,105.3). Five (0.2%) athletes required hospitalization for non-cardiac complications of SARS-CoV-2. During clinical surveillance (median follow-up 113 days [IQR=90,146]), there was one (0.03%) adverse cardiac event likely unrelated to SARS-CoV-2 infection. Conclusions: SARS-CoV-2 infection among young competitive athletes is associated with a low prevalence of cardiac involvement and a low risk of clinical events in short term follow-up.

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