Incidence of complications related to catheter ablation of atrial fibrillation and atrial flutter: a nationwide in-hospital analysis of administrative data for Germany in 2014

Abstract

AimsRisks of catheter ablation for atrial fibrillation and flutter assessed in retrospective studies, registries, and controlled trials may underestimate ‘real world’ conditions.Methods and resultsTo assess complications in a nationwide approach, we included all cases undergoing catheter ablation for atrial fibrillation and atrial flutter in Germany in 2014, using ICD-10-GM-based German Diagnosis Related Group (G-DRG) codes and the well differentiated German Operation and Procedure Classification (OPS) analysing 33 353 in-hospital cases. For left atrial ablations (19 514 cases), the overall complication rate ranged from a mean of 11.7% to 13.8% depending on type and site of applied energy, including major complications ranging from 3.8% to 7.2%. Whereas overall complication rates were lower for atrial flutter ablations (13 871 cases, 10.5%; P < 0.001), interestingly, major complications occurred more frequently (7.4%; P < 0.001). Particularly, in-hospital death was four-times more common following right than following left atrial ablations (47 vs. 18 cases, 0.34% vs. 0.09%; P < 0.001). Stratified by centre ablation volume, significantly fewer overall complications occurred in centres performing >100 vs. ≤100 left atrial ablations annually (12.7% vs. 16.4%; P < 0.002).ConclusionAdministrative data of all atrial fibrillation ablations in Germany in 2014 revealed higher overall and major complication rates than previously reported. Few patients were treated in low volume centres, but were exposed to a higher overall complication risk. Atrial flutter ablations were associated with surprisingly high rates of life-threatening complications. Advanced age combined with highly prevalent cardiac, pulmonary and, vascular comorbidities likely play a major role. In addition, individual-level clinical studies need to address the safety and benefits of catheter ablation in an elderly, diseased population.

Population‐level evaluation of complications after catheter ablation in patients with atrial fibrillation and heart failure

“…Although prior evaluations of the incidence of major AEs in AF patients who underwent CA included a low proportion of patients with comorbid HF (0.4% to 18%), the incidence of major AEs between 1% and 6% did not differ from the present study which only included patients with comorbid HF . Only two studies indicated that HF was a predictor for major AEs (univariate HR 5.2 [95% CI, 2.0‐13.4]); however, the comparable incidence between the present study and the safety evaluations of all AF patients undergoing CA seems to indicate no increase in AE risk with the addition of HF.…”

“…Although prior evaluations of the incidence of major AEs in AF patients who underwent CA included a low proportion of patients with comorbid HF (0.4% to 18%), the incidence of major AEs between 1% and 6% did not differ from the present study which only included patients with comorbid HF. 1,6,7,[10][11][12][13][14][15][16][17][18][19]36 Only two studies indicated that HF was a predictor for major AEs The ROCKET-AF 37 and ARISTOTLE 38 trials have identified the chronic obstructive pulmonary disorder as a predictor of all-cause mortality in the AF population. In addition, HAS-BLED risk score has been identified as a predictor of long-term adverse outcomes, including mortality, in the AF population as well as other cardiovascular diseases and postcardiac procedures.…”

Early versus delayed removal of the pericardial drain in patients with cardiac tamponade complicating radiofrequency ablation of atrial fibrillation

“…There were no significant adverse outcomes in either group in the present study except three patients with PCIS, while some significant adverse outcomes may occur after the procedure, such as sepsis, stroke and multiorgan failure. [15][16][17] Patients with delayed drain removal would have the propensity for enhanced inflammation reaction and a risk of infection, which would increase the possibility of those significant adverse outcomes. Early drain removal ultimately led to a quicker recovery with a significantly shorter hospital stay and high-quality, cost-effective care.…”

European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on risk assessment in cardiac arrhythmias: use the right tool for the right outcome, in the right population

“…Apart from AF recurrence, according to the available real‐world data, around 5%‐15% of patients undergoing AF catheter ablation experience complications, mainly during the index hospitalization and early in the post‐procedure course 320–325 . A variety of complications, including neurological, gastrointestinal, cardiovascular, vascular and peripheral, as well as pulmonary complications have been reported to occur after ablation procedures 320–325,343–347 . Although different modifiable factors such as metabolic syndrome, hypertension, alcohol consumption, sleep apnoea, and obesity have been proposed to be related with arrhythmia‐free survival after catheter ablation, 348–351 their impact on the ablation adverse outcomes is not clear yet, and requires further investigations.…”