Atrial Fibrillation Catheter Ablation Complications in Obese and Diabetic Patients: Insights from the US Nationwide Inpatient Sample 2005-2013.

2021 ◽  
Author(s):  
Shawn D’Souza ◽  
Mohamed B. Elshazly ◽  
Soha R . Dargham ◽  
Eoin Donnellan ◽  
Nidal Asaad ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Nationwide Inpatient Sample ◽  
Primary Outcome ◽  
Hospital Charges ◽  
Diabetic Patients ◽  
Complication Rates ◽  
Obesity And Diabetes ◽  
The Us ◽  
Annual Trends

Abstract Obesity and diabetes are risk factors for atrial fibrillation (AF) incidence and recurrence after catheter ablation. However, their impact on post-ablation complications in real-world practice is unknown. Using the Nationwide Inpatient Sample (2005–2013), we examine annual trends in AF ablations and outcomes in US patients with obesity and diabetes and perform multivariate analyses to assess whether they are independently associated with adverse outcomes. Our primary outcome included the composite of in-hospital complications or death. Annual trends for primary outcome, length-of-stay (LOS) and total inflation-adjusted hospital charges were examined. An estimated 106,462 AF-ablations were performed in the US from 2005–2013. There was a gradual annual increase in ablations performed in obese and diabetic patients and complication rates. The primary outcome rate was 11.7% in obese vs. 8.2% in non-obese and 10.7% in diabetic vs. 8.2% in non-diabetic patients (p < 0.001). Obesity was independently associated with increased complications (adjusted-OR, 95% CI:1.39, 1.20–1.62), longer LOS (1.36, 1.23–1.49), and higher charges (1.16, 1.12–1.19). Diabetes was only associated with longer LOS (1.27, 1.16–1.38). Hence obesity, but not diabetes, is an independent risk factor for immediate post AF ablation complications and higher costs. Future studies should investigate whether weight loss prior to ablation reduces complications and costs.

Atrial Fibrillation Catheter Ablation Complications in Obese and Diabetic Patients: Nationwide Inpatient Sample 2005-2013

2020 ◽  
Author(s):  
Shawn D’Souza ◽  
Mohamed, B. Elshazly ◽  
Soha, R. Dargham ◽  
Eoin Donnellan ◽  
Nidal Asaad ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Nationwide Inpatient Sample ◽  
Diabetic Patients

scholarly journals Randomized comparison between dexmedetomidine–remifentanil and midazolam–fentanyl for deep sedation during catheter ablation of atrial fibrillation

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Young Choi ◽  
Sung-Hwan Kim ◽  
Ju Youn Kim ◽  
Youmi Hwang ◽  
Tae-Seok Kim ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Primary Outcome ◽  
Secondary Outcome ◽  
Positive Pressure ◽  
Efficacy And Safety ◽  
Af Ablation ◽  
Hemodynamic Compromise ◽  
3D Mapping System ◽  
Sedative Agents

Abstract Background and objectives The efficacy of dexmedetomidine for radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) has not been well established. We evaluated the efficacy and safety of sedation using dexmedetomidine with remifentanil compared to conventional sedative agents during RFCA for AF. Subjects and methods A total of 240 patients undergoing RFCA for AF were randomized to either the dexmedetomidine (DEX) group (continuous infusion of dexmedetomidine and remifentanil) or the midazolam (MID) group (intermittent injections of midazolam and fentanyl) according to sedative agents. Non-invasive positive pressure ventilation was applied to all patients during the procedure. The primary outcome was patient movement during the procedure resulting in a 3D mapping system discordance, and the secondary outcome was adverse events including respiratory or hemodynamic compromise. Results During AF ablation, the incidence of the primary outcome was significantly reduced for the DEX group (18.2% vs. 39.5% in the DEX and the MID groups, respectively, p < 0.001). The frequency of a desaturation event (oxygen saturation < 90%) did not significantly differ between the two groups (6.6% vs. 1.7%, p = 0.056). However, the incidences of hypotension not owing to cardiac tamponade (systolic blood pressure < 80 mmHg, 19.8% vs. 8.4%, p = 0.011) and bradycardia (HR < 50 beats/min: 39.7% vs. 21.8%, p = 0.003) were higher in the DEX group. All efficacy and safety results were consistent within the predefined subgroups. Conclusion The combined use of dexmedetomidine and remifentanil provides higher stability sedation during AF ablation, but can lead to more frequent hemodynamic compromise compared to midazolam and fentanyl.

scholarly journals Factors impacting complication rates for catheter ablation of atrial fibrillation from 2003 to 2015

EP Europace ◽  
2016 ◽  
pp. euw178 ◽  
Author(s):  
Eunice Yang ◽  
Esra Gucuk Ipek ◽  
Muhammad Balouch ◽  
Yuliya Mints ◽  
Jonathan Chrispin ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Complication Rates

scholarly journals Clinical Outcomes of Computational Virtual Mapping-Guided Catheter Ablation in Patients With Persistent Atrial Fibrillation: A Multicenter Prospective Randomized Clinical Trial

2021 ◽  
Vol 8 ◽  
Author(s):  
Yong-Soo Baek ◽  
Oh-Seok Kwon ◽  
Byounghyun Lim ◽  
Song-Yi Yang ◽  
Je-Wook Park ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Trial ◽  
Catheter Ablation ◽  
Computational Modeling ◽  
Controlled Trial ◽  
Dominant Frequency ◽  
Complication Rates ◽  
Clinical Recurrence ◽  
Significant Difference

Background: Clinical recurrence after atrial fibrillation catheter ablation (AFCA) still remains high in patients with persistent AF (PeAF). We investigated whether an extra-pulmonary vein (PV) ablation targeting the dominant frequency (DF) extracted from electroanatomical map–integrated AF computational modeling improves the AFCA rhythm outcome in patients with PeAF.Methods: In this open-label, randomized, multi-center, controlled trial, 170 patients with PeAF were randomized at a 1:1 ratio to the computational modeling-guided virtual DF (V-DF) ablation and empirical PV isolation (E-PVI) groups. We generated a virtual dominant frequency (DF) map based on the atrial substrate map obtained during the clinical AF ablation procedure using computational modeling. This simulation was possible within the time of the PVI procedure. V-DF group underwent extra-PV V-DF ablation in addition to PVI, but DF information was not notified to the operators from the core lab in the E-PVI group.Results: After a mean follow-up period of 16.3 ± 5.3 months, the clinical recurrence rate was significantly lower in the V-DF than with E-PVI group (P = 0.018, log-rank). Recurrences appearing as atrial tachycardias (P = 0.145) and the cardioversion rates (P = 0.362) did not significantly differ between the groups. At the final follow-up, sinus rhythm was maintained without any AADs in 74.7% in the V-DF group and 48.2% in the E-PVI group (P &lt; 0.001). No significant difference was found in the major complication rates (P = 0.489) or total procedure time (P = 0.513) between the groups. The V-DF ablation was independently associated with a reduced AF recurrence after AFCA [hazard ratio: 0.51 (95% confidence interval: 0.30–0.88); P = 0.016].Conclusions: The computational modeling-guided V-DF ablation improved the rhythm outcome of AFCA in patients with PeAF.Clinical Trial Registration: Clinical Research Information Service, CRIS identifier: KCT0003613.

Complication Rates of Catheter Ablation of Atrial Fibrillation in Patients Aged ≥75 Years versus <75 Years-Results from the German Ablation Registry

2017 ◽  
Vol 28 (3) ◽  
pp. 258-265 ◽  
Author(s):  
JULIA M. MOSER ◽  
STEPHAN WILLEMS ◽  
DIETRICH ANDRESEN ◽  
JOHANNES BRACHMANN ◽  
LARS ECKARDT ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Complication Rates

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

Circulation ◽  
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.

scholarly journals Ablation of Atrial Fibrillation in Patients with Hypertension—An Analysis from the German Ablation Registry

2020 ◽  
Vol 9 (8) ◽  
pp. 2402
Author(s):  
Maura M. Zylla ◽  
Matthias Hochadel ◽  
Dietrich Andresen ◽  
Johannes Brachmann ◽  
Lars Eckardt ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Clinical Symptoms ◽  
Nyha Class ◽  
Heart Association ◽  
Complication Rates ◽  
Bleeding Events ◽  
Term Outcome ◽  
Long Term Outcome

Background: Hypertension (HTN) constitutes a risk factor for the development of atrial fibrillation (AF), as well as for thromboembolic and bleeding events. We analysed the outcome after catheter ablation of AF in HTN in a cohort from the prospective multicenter German Ablation Registry. Methods: Between 03/2008 and 01/2010, 626 patients undergoing AF-ablation were analysed. Patients diagnosed with HTN (n = 386) were compared with patients without HTN (n = 240) with respect to baseline, procedural and long-term outcome parameters. Results: Patients with HTN were older and more often presented with persistent forms of AF and cardiac comorbidities. Major and moderate in-hospital complications were low. At long-term follow-up, major cardiovascular events were rare in both groups. Rates of AF-recurrence, freedom from antiarrhythmic medication and repeat ablation were not statistically different between groups. Most patients reported improvement of symptoms and satisfaction with the treatment. However, patients with HTN more frequently complained of dyspnea of New York Heart Association (NYHA) class ≥ II and angina. They were more often rehospitalized, particularly when persistent AF had been diagnosed. Conclusion: Catheter ablation of AF is associated with low complication rates and favorable arrhythmia-related results in patients with HTN. Residual clinical symptoms may be due to cardiac comorbidities and require additional attention in this important subgroup of AF-patients.

Pulmonary vein isolation alone vs. more extensive ablation with defragmentation and linear ablation of persistent atrial fibrillation: the EARNEST-PVI trial

EP Europace ◽  
2020 ◽  
Author(s):  
Koichi Inoue ◽  
Shungo Hikoso ◽  
Masaharu Masuda ◽  
Yoshio Furukawa ◽  
Akio Hirata ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Primary Endpoint ◽  
Persistent Atrial Fibrillation ◽  
Hazard Ratio ◽  
Complication Rates ◽  
Inferior Margin ◽  
Linear Ablation

Abstract Aims Previous studies could not demonstrate any benefit of more intensive ablation in addition to pulmonary vein isolation (PVI) including complex fractionated atrial electrogram (CFAE) and linear ablation for recurrence in the initial catheter ablation of persistent atrial fibrillation (AF). This study aimed to establish the non-inferiority of PVI alone to PVI plus these additional ablation strategies. Methods and results Patients with persistent AF who underwent an initial catheter ablation (n = 512, long-standing persistent AF; 128 cases) were randomly assigned in a 1:1 ratio to either PVI alone (PVI-alone group) or PVI plus CFAE and/or linear ablation (PVI-plus group). After excluding 15 cases who did not receive procedures, we analysed 249 and 248 patients, respectively. The primary endpoint was recurrence of AF, atrial flutter, and/or atrial tachycardia, and the non-inferior margin was set at a hazard ratio of 1.43. In the PVI-plus group, 85.1% of patients had linear ablation and 15.3% CFAE ablation. After 12 months, freedom from the primary endpoint occurred in 71.3% of patients in the PVI-alone group and in 78.3% in the PVI-plus group [hazard ratio = 1.56 (95% confidence interval: 1.10–2.24), non-inferior P = 0.3062]. The procedure-related complication rates were 2.0% in the PVI-alone group and 3.6% in the PVI-plus group (P = 0.199). Conclusion This randomized trial did not establish the non-inferiority of PVI alone to PVI plus linear ablation or CFAE ablation in patients with persistent AF, but implied that the PVI plus strategy was promising to improve the clinical efficacy (NCT03514693).

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

EP Europace ◽  
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 &lt;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 &lt;80 years (62.4 ± 9.5 years, 34.7% females), p &lt;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 &lt; 80yrs) n = 216 P value Age (yrs), mean (SD)s 81.9 (1.9) 62.4(9.5) &lt; 0.0001 Females, (%) 52.8 34.7 0.0002 CHA2DS2-VASc, mean (SD) 3.6 (1.2) 1.4 (1.3) &lt; 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 &lt; 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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