Abstract 330: Thirty-day Incidence of Cardiac Tamponade and Mortality Following Catheter or Surgical Ablation of Atrial Fibrillation

Background: The risks of cardiac tamponade and mortality during the first 30 days following catheter or surgical atrial fibrillation (AF) ablation are not well known. Previous large population studies have been limited to in-hospital complication rates and might significantly underestimate the risks of these procedures. Methods: This population based retrospective cohort study was conducted using a large national representative administrative claims database, the Medical Outcomes Research for Effectiveness and Economics Registry (MORE2 Registry®). Thirty-day incidence rates of cardiac tamponade and mortality were calculated and compared by type of procedure (i.e. catheter or surgical), patient gender and age. We analyzed 38,974 AF ablation procedures (catheter: 30,758, 78.9%; surgical: 8,216, 21.1%; age 80 or older: 6,077, 15.6%; 65 to 79: 19,572, 50.2%; 50 to 64: 10,243, 26.3%; 18 to 49: 3,082, 7.9%) performed on 35,754 patients (men: 21,879, 61.2%; women: 13,875, 38.8%) from 2007 to 2012. Results: Thirty-day incidence of cardiac tamponade was 1.74% and differed significantly by type of procedure (catheter: 1.51% vs. surgical: 2.62%, p<0.001) and gender (men: 1.60% vs. women: 1.96%, p=0.010), but not by age group (18-49: 1.49%; 50-64: 1.77%; 65-79: 1.91%; 80 or older: 1.28%, p=0.425). The thirty-day mortality rate was 1.15% and differed significantly by type of procedure (catheter: 0.70% vs. surgical: 2.76%, p<0.001), but not by gender (men: 1.06% vs. women: 1.29%, p=0.058). The mortality rate did not differ significantly from the youngest age group to the next oldest (18 to 49: 0.33% vs. 50 to 64: 0.21%, p=0.315), but increased significantly for the oldest age groups (65 to 79: 1.28%; 80 or older: 2.75%, p<0.001). Conclusion: The 30-day risks of both cardiac tamponade and mortality following catheter AF ablation are greater than the in-hospital rates reported in a previous study. Surgical AF ablation has significantly higher 30-day rates of both cardiac tamponade and mortality, compared to catheter AF ablation. The risk of cardiac tamponade is greater for women than men, but does not vary significantly by age group. Conversely, the risk of mortality is greater for patients age 65 and older, but is not significantly different for women compared to men. These findings provide new comparative safety information that can help inform optimal treatment practices and could serve as the basis of a physician or facility quality measure designed to evaluate relative performance and provide benchmarks to support both consumer choice and quality improvement efforts.

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Abstract 17132: Atrial Fibrillation Ablation in Heart Failure: Temporal Trends and Outcomes in Hospitalized Patients

Circulation ◽

10.1161/circ.138.suppl_1.17132 ◽

2018 ◽

Vol 138 (Suppl_1) ◽

Author(s):

Manyoo Agarwal ◽

Brijesh Patel ◽

Lohit Garg ◽

Mahek Shah ◽

Rami Khouzam ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Catheter Ablation ◽

Mortality Rate ◽

Hospital Mortality ◽

Temporal Trends ◽

Complication Rates ◽

Af Ablation ◽

Southern Us ◽

Comorbidity Burden

Introduction: Recent studies have shown catheter ablation for atrial fibrillation (AF) in patients with heart failure (HF) to have better outcomes over medical therapy. While AF ablation is predominantly an outpatient procedure, some patients may require longer hospitalization. Limited literature exists describing the trends of hospitalizations for HF patients undergoing AF ablation. Methods: Using ICD-9 (diagnosis and procedure codes) in nationwide inpatient sample database 2003 to 2014, we identified all HF adults who were admitted with a principal diagnosis code of AF (427.31) (n= 4,670,400) (AF-HF). Among these, we identified those with a principal procedure code of catheter ablation (37.34) and studied the temporal trends of clinical characteristics and outcomes (in-hospital mortality and complications) for this cohort (Table). Results: The overall number of AF-HF patients undergoing AF ablation was 62,653; with an increase from 1,928 in 2003 to 6,860 in 2014 (p trend<0.001). As shown in Table, over this 12-year period; mean age and proportion of females decreased, while there was an increase in blacks, clinical comorbidity burden, admissions to teaching hospitals and southern US region (all p trend<0.001). The overall procedure related complications (vascular, cardiac, respiratory, neurologic) increased, the in-hospital mortality rate decreased from 1.7% to 0.5% (all p trend<0.001). Conclusions: During 2003-2014, the annual incidence of AF ablation related hospitalizations in HF patients increased significantly. Despite increase in clinical comorbidities burden and procedural complication rates, the mortality rate declined.

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Catheter-related complications and mortality of atrial fibrillation ablation following introduction of contact force-sensing technology

BMJ Surgery, Interventions, & Health Technologies ◽

10.1136/bmjsit-2020-000058 ◽

2020 ◽

Vol 2 (1) ◽

pp. e000058

Author(s):

Joseph G Akar ◽

James P Hummel ◽

Xiaoxi Yao ◽

Lindsey Sangaralingham ◽

Sanket Dhruva ◽

...

Keyword(s):

Atrial Fibrillation ◽

Acute Care ◽

Contact Force ◽

Emergency Department Visits ◽

Atrial Fibrillation Ablation ◽

Esophageal Injury ◽

Force Sensing ◽

Complication Rates ◽

Af Ablation ◽

Complications And Mortality

ObjectivesContact force-sensing catheters allow real-time catheter-tissue contact force monitoring during atrial fibrillation. These catheters were rapidly adopted into clinical practice following market introduction in 2014, but concerns have been raised regarding collateral damage such as esophageal injury. We sought to examine whether the introduction of force-sensing catheters was associated with a change in short-term and intermediate-term acute care use, complications and mortality following atrial fibrillation ablation.DesignRetrospective cohort analysis. We used inverse probability treatment weight matching to account for the differences in baseline characteristics between groups.SettingWe examined patients included in the OptumLabs Data Warehouse who underwent ablation for atrial fibrillation before (2011–2013) and after (2015–2017) the market introduction of contact force-sensing catheters.Main outcome measuresWe examined 30-day and 90-day rates of all-cause acute care use, including hospitalizations and emergency department visits, as well as death and hospitalization for catheter-related complications, including atrioesophageal fistula, pericarditis, cardiac tamponade/perforation and stroke/transient ischemic attack.ResultsOur sample included 3470 and 5772 patients who underwent atrial fibrillation (AF) ablation before and after market introduction of contact force-sensing catheters, respectively. Complication rates were low and did not differ between the two periods (p>0.10 for each outcome). The 30-day and 90-day mortality was 0.1% and 0.3%, respectively after market introduction and unchanged from prior to 2014. The 90-day rates of all-cause acute care use decreased, from 27.0% in 2011–2013 to 23.9% in 2015–2017 (p<0.001).ConclusionsAF ablation-related catheter complications and mortality are low and there has been no significant change following the introduction of force-sensing catheters.

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Abstract W MP66: Rates of Ischemic Stroke after Intracranial Hemorrhage in a Population-Based Sample of Patients with Atrial Fibrillation

Stroke ◽

10.1161/str.46.suppl_1.wmp66 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Michael P Lerario ◽

Gino Gialdini ◽

Daniel Lapidus ◽

Mesha Shaw ◽

Babak Navi ◽

...

Keyword(s):

Atrial Fibrillation ◽

Intracranial Hemorrhage ◽

Anticoagulant Therapy ◽

Stroke Risk ◽

Hazard Analysis ◽

Large Population ◽

Population Based ◽

Administrative Claims ◽

Index Visit

Introduction: Patients with atrial fibrillation (AF) who experience intracranial hemorrhage (ICH) often cannot tolerate anticoagulant therapy and presumably face a higher risk of thromboembolism. However, there are little population-based data on long-term rates of stroke after ICH in patients with AF. Methods: Using validated diagnosis codes and administrative claims data from all nonfederal acute care hospitals and emergency departments in California, Florida, and New York from 2005 to 2012, we identified patients at their first encounter with a recorded diagnosis of AF. We excluded patients with diagnoses of stroke or ICH prior to their index visit or a diagnosis of stroke at the index visit. A time-varying covariate was used to account for ICH (intracerebral or subarachnoid hemorrhage) at the index visit or during follow-up. Kaplan-Meier survival statistics were used to calculate cumulative rates of stroke, and Cox proportional hazard analysis was used to evaluate the relationship between incident ICH and stroke while adjusting for the CHA 2 DS 2 VASc score. Results: During a mean 3.2 years of follow-up among 2,376,207 patients with AF, 25,243 (1.06%) developed ICH and 93,183 (3.92%) developed stroke. The cumulative 1-year rate of stroke was 6.50% (95% CI, 6.06-6.96%) after ICH versus 2.22% (95% CI, 2.20-2.24) in those without ICH. ICH remained associated with higher stroke risk after adjusting for the CHA 2 DS 2 VASc score (HR, 2.29; 95% CI, 2.18-2.40). Among patients with ICH, stroke risk rose in step with the CHA 2 DS 2 VASc score. Conclusions: In a large population-based cohort, patients with AF faced a substantially higher risk of stroke after ICH. This risk rose proportionally with increasing CHA 2 DS 2 VASc score. These findings point to patients with AF and ICH as a vulnerable population who may especially benefit from therapeutic alternatives to anticoagulant therapy for preventing thromboembolism in AF.

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Atrial fibrillation ablation with a spring sensor-irrigated contact force-sensing catheter compared with other ablation catheters: systematic literature review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2018-023775 ◽

2019 ◽

Vol 9 (6) ◽

pp. e023775 ◽

Cited By ~ 7

Author(s):

Laurent Macle ◽

Diana Frame ◽

Larry M Gache ◽

George Monir ◽

Scott J Pollak ◽

...

Keyword(s):

Atrial Fibrillation ◽

Literature Review ◽

Contact Force ◽

Systematic Literature Review ◽

Meta Analysis ◽

Safety Data ◽

Percutaneous Ablation ◽

Complication Rates ◽

Success Rates ◽

Af Ablation

ObjectivesThe objective of our review was to systematically assess available evidence on the effectiveness, safety and efficiency of a spring sensor-irrigated contact force (CF) catheter (THERMOCOOL SMARTTOUCH Catheter (ST)) for percutaneous ablation of paroxysmal or persistent atrial fibrillation (AF), compared with other ablation catheters, or with the ST with the operator blinded to CF data.DesignSystematic literature review and meta-analysis.BackgroundEmerging evidence suggests improved clinical outcomes of AF ablation using CF-sensing catheters; however, reviews to date have included data from multiple, distinct CF technologies.MethodsWe conducted a systematic review and meta-analysis of published studies comparing the use of ST versus other ablation catheters for the treatment of AF. A comprehensive search of electronic and manual sources was conducted. The primary endpoint was freedom from recurrent atrial tachyarrhythmia (AT) at 12 months. Procedural and safety data were also analysed.ResultsThirty-four studies enrolling 5004 patients were eligible. The use of ST was associated with increased odds of freedom from AT at 12 months (71.0%vs60.8%; OR 1.454, 95% CI 1.12 to 1.88, p=0.004) over the comparator group, and the effect size was most evident in paroxysmal AF patients (75.6%vs64.7%; OR 1.560, 95% CI 1.09 to 2.24, p=0.015). Procedure and fluoroscopy times were shorter with ST (p=0.05 and p<0.01, respectively, vs comparator groups). The reduction in procedure time is estimated at 15.5 min (9.0%), and fluoroscopy time 4.8 min (18.7%). Complication rates, including cardiac tamponade, did not differ between groups.ConclusionsCompared with the use of other catheters, AF ablation using the CF-sensing ST catheter for AF is associated with improved success rates, shorter procedure and fluoroscopy times and similar safety profile.

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Safety and acute clinical outcomes of atrial fibrillation catheter ablation in octogenarians: a multicentre evaluation with a matched younger cohort

EP Europace ◽

10.1093/europace/euab116.235 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

N Karim ◽

N Kozhuharov ◽

J Jarman ◽

S Furniss ◽

R Veasey ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

De Novo ◽

Lv Function ◽

P Value ◽

Complication Rates ◽

Success Rates ◽

Af Ablation ◽

Funding Sources ◽

Procedural Success

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf Sven Knecht and the International Octogenarian AF ablation group Background Octogenarians are a fast-growing demographic with a high burden of atrial fibrillation (AF). There are limited data on procedural safety and acute outcomes of catheter ablation (CA) for AF in this group. Purpose Investigation of complications & outcomes in octogenarians undergoing CA for AF. Methods Data on all octogenarian patients who underwent AF ablation at nine European cardiology centres between 2013 and 2019 were retrospectively analysed and matched with control patients aged <80 years. The characteristics used for matching were type of AF, type of procedure (de novo or redo), & the year of procedure. Results 216 octogenarians (81.9 ± 1.9 years; 52.8% females) underwent an AF ablation procedure, and were matched with 216 patients aged <80 years (62.4 ± 9.5 years, 34.7% females), p <0.001 for both. The proportion of paroxysmal and persistent AF was 43.5% & 56.5% respectively in both groups, and 79.3% of the procedures were de novo. RF ablation made up 75.4% & 75.9% (p = 0.90) procedures in octogenarians and controls respectively. 17 complications occurred in 14 (7.9%) octogenarian patients and 11 in 11 (5.1%) patients in the younger matched cohort (p = 0.07). There were 4.2% & 1.9% major complications (p= 0.17) and 3.7% & 3.2% minor complications (p= 0.77) in the octogenarian & younger cohorts respectively. Complications in octogenarians consisted of groin complications (n = 6), pneumonia (n = 3), pericardial effusion (n = 2), phrenic nerve injury (n = 2), pulmonary oedema (n = 1), gastroparesis (n = 1), stroke (n = 1). Acute procedural success rates were 99.1% & 99.5% (p = 0.62) The complication rates were similar for RF; 6.0% vs 5.4% (p = 0.79) and Cryoballoon; 14.0% vs 4.1% (p = 0.09) in both octogenarians and younger cohort respectively. Conclusion In spite of significantly higher overall risk profile of octogenarians undergoing AF ablation, there is no difference in acute procedural success and complication rates as compared to younger patients Catheter ablation of AF in octogenerians Octogenarians n = 216 Matched Controls (aged < 80yrs) n = 216 P value Age (yrs), mean (SD)s 81.9 (1.9) 62.4(9.5) < 0.0001 Females, (%) 52.8 34.7 0.0002 CHA2DS2-VASc, mean (SD) 3.6 (1.2) 1.4 (1.3) < 0.0001 Mean LA size, mm 42.8 ± 8.3mm 45.8 ± 16.2 0.062 Impaired LV function, (%) 23.7 17.9 0.206 IHD, (%) 20.7 5.9 < 0.0001 Procedural time (mins), mean (sd) 150.6 (69.7) 148.9 (64.4) 0.914 All complications, n (%) 17 (7.9) 11 (5.1) 0.073

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Efficacy of high-power and short-duration ablation in patients with atrial fibrillation: a prospective randomized controlled trial

EP Europace ◽

10.1093/europace/euaa144 ◽

2020 ◽

Vol 22 (10) ◽

pp. 1495-1501 ◽

Cited By ~ 1

Author(s):

Dong Geum Shin ◽

Jinhee Ahn ◽

Sang-Jin Han ◽

Hong Euy Lim

Keyword(s):

Atrial Fibrillation ◽

Short Duration ◽

High Power ◽

Controlled Trial ◽

Posterior Wall ◽

Complication Rates ◽

Related Complication ◽

Af Ablation ◽

Ablation Index ◽

Significant Difference

Abstract Aims The formation of radiofrequency lesions depends on the power and duration of ablation, and the contact force (CF). Although high power (HP) creates continuous and transmural lesions, most centres still use 25–30 W for 30–40 s for safety reasons. We evaluated the clinical efficacy and safety of a HP and short-duration (HPSD) strategy for atrial fibrillation (AF) ablation. Methods and results One hundred and fifty patients [58.2 ± 10.0 years, 48% with paroxysmal AF (PAF)] scheduled for index AF ablation using a CF-sensing catheter were randomly assigned to three groups [30 W, 40 W, and 50 W at ablation sites of anterior, roof, and inferior segments of pulmonary vein (PV) antra and roof line between each upper PV]. In 25–30 W for ≤20 s was applied at posterior wall ablation site in all subjects. Compared with the 30 W and 40 W groups, procedure (P < 0.001) and ablation times (P < 0.001) were shorter and ablation number for PV isolation (P < 0.001) was smaller in the 50 W group. There were no significant differences in the CF and ablation index (AI) among the three groups. There were no significant differences in the procedure-related complication rates. During the 12-month follow-up, AF recurred in 24 (16%) patients with no significant difference among the groups (P = 0.769). In the multivariate analysis, non-PAF [hazard ratio (HR) 2.836, P = 0.045] and AI (HR 0.983, P = 0.001) were independent risk factors for AF recurrence. Conclusion Radiofrequency ablation with HPSD is a safe and effective strategy with reduced ablation number and shortened procedure time compared to conventional ablation.

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Case report: Managing profound circulatory collapse post-atrial fibrillation ablation: a methodical approach

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa324 ◽

2020 ◽

Author(s):

Ven Gee Lim ◽

Tarv Dhanjal ◽

Sandeep Panikker ◽

Faizel Osman

Keyword(s):

Atrial Fibrillation ◽

Cardiac Tamponade ◽

Pulmonary Vein ◽

Vascular Injury ◽

Circulatory Collapse ◽

Term Outcome ◽

Long Term Outcome ◽

Af Ablation ◽

Oesophageal Injury ◽

Balloon Ablation

Abstract Background Circulatory collapse during/post-pulmonary vein (PV) isolation by cryo-balloon ablation is a Cardiology emergency that has multiple potential causes and requires a methodical investigative approach. Some of the complications that can arise include cardiac tamponade, bleeding/vascular injury, anaphylaxis, Addisonian crisis, acute pulmonary embolism, acute PV stenosis, oesophageal injury, and vagal reaction. Case summary Here, we present a case of a 76-year-old lady who developed profound circulatory collapse during an elective pulmonary vein isolation by cryo-balloon ablation for symptomatic paroxysmal atrial fibrillation (AF). Cardiac tamponade, bleeding/vascular injury, and other less common causes were excluded. She only responded transiently to fluid resuscitation and developed intermittent bradyarrhythmias and hypotension which responded to isoprenaline. She was discharged home at Day 3 post-AF ablation after remaining well and continued to do so at follow-up. Discussion Circulatory collapse during/post-PV cryo-balloon ablation is a Cardiology emergency that has multiple potential causes. The ganglionate plexi form part of the cardiac intrinsic autonomic nervous system (ANS) and are located close to the left atrial–PV junctions. The presence of vagal response has been observed to be a marker of ANS modulation although its significance on the long-term outcome post-ablation has yet to be elucidated. The true cause of our patient’s profound circulatory collapse is uncertain but a vital learning point in this case is the systematic exclusion of common and potentially life-threatening complications following AF ablation. A persistent vagal reaction secondary to PV cryo-balloon ablation can usually be managed with supportive medical therapy as demonstrated in our case.

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Low mortality rate after atrial fibrillation ablation: results from the Netherlands Heart Registration

European Heart Journal ◽

10.1093/ehjci/ehaa946.0446 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

D Mol ◽

M.M Roefs ◽

Y Blaauw ◽

J.S.S.G De Jong ◽

J.R De Groot

Keyword(s):

Atrial Fibrillation ◽

Mortality Rate ◽

The Netherlands ◽

Ejection Fraction ◽

High Volume ◽

The United States ◽

Left Ventricular ◽

Ablation Therapy ◽

Af Ablation ◽

Lv Ejection Fraction

Abstract Background Ablation therapy is widely used as a treatment of atrial fibrillation (AF) and is associated with 3.6% minor and major complications in the Netherlands. Mortality following AF ablation is rare, but has been reported 0.46% in the United States in recent literature. We hypothesize that in the Netherlands, where AF ablation is performed in high volume centres only, 30-day mortality rate is low. Purpose To describe 30-day mortality in the Netherlands after AF ablation. Methods In the Netherlands Heart Registration, all 16 Dutch ablation centres participate and 14 out of 16 centres reported AF ablation outcomes using predefined variables for quality purposes. The number of reported procedures per centre was on average 236/year [range, 33–593], where 87.5% of the centres perform >150 AF ablations per year. All patients who underwent AF ablation were eligible for this analysis irrespective of ablation method used, or whether it was the first or a redo AF ablation. 30-day mortality was derived from, the municipal death registration, and individually checked by each participating ablation centre. No further analysis was available on the cause of death. Results In total, 20,230 patients who underwent AF ablation between 01-01-2013 and 31-12-2018 were included. The majority of patients were male (68%), mean age was 60.9±9.8 years, mean body mass index was 27.3±4.2kg/m2, and the average CHA2DS2VASc score was 1.6±1.3. Reduced left ventricular (LV) ejection fraction (<50%) was present in 13.2% of the patients. Paroxysmal AF was present in 72.7% of patients, persistent AF in 24.9% and longstanding persistent in 2.3%. The index procedure was a redo-ablation in 22.7%. Mortality outcomes were available for 18,413 (91.0%) procedures, as some centres had a backlog of patients that needed death certificate checking [range, 0% - 19.4%], this factor was considered random. In total 12 patients (0.07%) died within 30-days after an AF ablation procedure. These patients were 68.5 years old [range, 55–76 years], 91.7% had a history of paroxysmal AF and 8.3% persistent AF, LV ejection fraction was <50% in 8.3% and 25% of the patients had a previous AF ablation (p=0.02 for age, others p=NS). Conclusion Patients undergoing AF ablation in the Netherlands mainly presented with paroxysmal AF. In a setting where AF ablation is performed in high volume centres only, such as the Netherlands, 30-day mortality is very low after AF ablation. Funding Acknowledgement Type of funding source: None

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Impact of centre volume on atrial fibrillation ablation outcomes in Europe: a report from the ESC EHRA EORP Atrial Fibrillation Ablation Long-Term (AFA LT) Registry

EP Europace ◽

10.1093/europace/euaa236 ◽

2020 ◽

Author(s):

Vassilios P Vassilikos ◽

Efstathios D Pagourelias ◽

Cécile Laroche ◽

Carina Blomström-Lundqvist ◽

Josef Kautzner ◽

...

Keyword(s):

Atrial Fibrillation ◽

Success Rate ◽

Cardiovascular Complications ◽

Atrial Fibrillation Ablation ◽

Complication Rates ◽

Stroke Incidence ◽

Af Ablation ◽

Long Term Study ◽

Low Volume

Abstract Aims The aim of the study was to investigate differences in clinical outcomes and complication rates among European atrial fibrillation (AF) ablation centres related to the volume of AF ablations performed. Methods and results Data for this analysis were extracted from the ESC EHRA EORP European AF Ablation Long-Term Study Registry. Based on 33rd and 67th percentiles of number of AF ablations performed, the participating centres were classified into high volume (HV) (≥ 180 procedures/year), medium volume (MV) (<180 and ≥74/year), and low volume (LV) (<74/year). A total of 91 centres in 26 European countries enrolled in 3368 patients. There was a significantly higher reporting of cardiovascular complications and stroke incidence in LV centres compared with HV and MV (P = 0.039 and 0.008, respectively) and a lower success rate after AF ablation (55.3% in HV vs. 57.2% in LV vs. 67.4% in MV centres, P < 0.001), despite lower CHA2DS2-VASc score of patients, enrolled in LVs and less complex ablation techniques used. Adjustments of confounding factors (including type of AF ablation) led to elimination of these differences. Conclusion Low-volume centres tended to present slightly higher cardiovascular complications’ and stroke incidence and a lower unadjusted success rate after AF ablation, despite the fact that ablation procedures and patients were of lower risk compared with MV and HV centres. On the other hand, adjusted overall complication and recurrence rates were non-significantly different among different volume centres, a fact reflecting the heterogeneity of patient and procedural profiles, and a counterbalance between expertise and risk level among participating centres.

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Increasing use of ablation in the management of atrial fibrillation in heart failure: insights from a national database on 10 year trends in the United States

European Heart Journal ◽

10.1093/ehjci/ehaa946.0395 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

B Narasimhan ◽

L Wu ◽

A Shah ◽

B Kantharia

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Clinical Practice ◽

Control Strategies ◽

The United States ◽

Rhythm Control ◽

National Database ◽

Complication Rates ◽

Short Term ◽

Af Ablation

Abstract Background Atrial fibrillation (AF) is the most commonly encountered arrhythmia in clinical practice, even more so among patients with heart failure (HF). Results of the recent CABANA and CASTLE-AF trials indicate significant improvements in ejection fraction, HF readmissions as well as overall mortality with the incorporation of rhythm control strategies in HF patients. These findings challenge existing notions of equivalency of rate vs rhythm control strategies. In this study, we analyzed the impact of this evidence on treatment practices and the short term outcomes of ablation in this patient cohort. Methods We conducted a retrospective study using the AHRQ-HCUP National Readmission Database for the years 2005–2014. ICD 9 diagnosis codes were used to identify all adult patients (≥18 years) undergoing AF ablation procedures as well as a sub-cohort of patients with existing HF. Trends in the use of ablation procedures, patient characteristics as well as details of short term procedural outcomes were studied. Multivariate regression analysis was utilized to adjust for confounders. Complications were defined as per the Agency for healthcare research and quality guidelines. Independent risk factors for in-hospital mortality were identified using proportional hazards model. Results Our results indicate a trend of rising rates of AF ablation procedures overall with a peak in 2011 at 20,046 and gradual downtrend thereafter (10,195 in 2005 to 11735 in 2014). Our data revealed a consistent rise in ablation procedures among heart failure patients during the same period (832 to 2245). A definite reduction in peri-procedural mortality is noted (0.24% in 2005 to 0.17% in 2014, p=0.2) – an improvement that is maximally apparent in the heart failure group (2.49% to 0.4%, p=0.07). Overall complication rates however are significantly increased overall with a proportional rise noted among HF patients. Conclusions Our data from a nationally representative registry indicates an increasing utilization of ablation as a therapeutic modality in the management of atrial fibrillation in HF. Future prospective studies are required to assess the positive impact of these changes in clinical practice as offset by their associated complications. 10 year AF ablation trends in HF Funding Acknowledgement Type of funding source: None

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