Risk of Mortality Following Catheter Ablation of Atrial Fibrillation

Cheng, Edward P.; Liu, Christopher F.; Yeo, Ilhwan; Markowitz, Steven M.; Thomas, George; Ip, James E.; Kim, Luke K.; Lerman, Bruce B.; Cheung, Jim W.

doi:10.1016/j.jacc.2019.08.1036

Cited by 110 publications

(102 citation statements)

References 19 publications

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“…To the best of our knowledge, this study is the first to examine patients with HF and AF undergoing CA on a nationwide basis with ICD‐10‐CM coding. The use of ICD‐10‐CM coding provides significant benefit in disease diagnosis and procedural specificity over the ICD‐9‐CM coding system, which prior studies have used 5,12‐15 . Moreover, throughout the last decade, the technology and treatment modalities of AF CA have considerably changed, thus limiting interpretation of older studies.…”

Section: Discussionmentioning

confidence: 99%

Thirty‐day readmissions after atrial fibrillation catheter ablation in patients with heart failure

Lima

Kennedy

Sheikh

et al. 2020

Pacing Clinical Electrophis

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Background Randomized clinical trial data have demonstrated catheter ablation (CA) as a viable treatment modality for atrial fibrillation (AF). Patients with heart failure (HF) undergoing AF CA appear to derive improvements in quality of life and mortality compared to those treated with medical therapy (MT). Contemporary national data on 30‐day readmissions after CA compared to MT among patients with HF are lacking. Methods From the 2016 Nationwide Readmissions Databases, 749 776 (weighted national estimate: 1 421 673) AF HF patients were identified of which 2204 (0.3%) underwent CA and 747 572 (99.7%) received MT. Propensity matching balanced baseline clinical characteristics. Thirty‐day readmission rates, causes, predictors, and costs of 30‐day readmission were compared. Results Among both the unmatched and matched cohorts, 30‐day readmissions were lower for patients treated with CA compared to MT (16.8% vs 20.1%, P < .001 and 16.8% vs 18.8%, P = .020). CA was associated with reduced risk of readmission compared to MT (odds ratio 0.86, 95% confidence interval [CI]: 0.77‐0.97). HF exacerbation and arrhythmias were the most common cause for 30‐day readmission after CA. CA costs were higher during index hospitalization but similar to MT during readmission among the matched cohort ($15 858 ± $21 636 vs $16 505 ± $29 171, P = .67). Predictors of readmission were largely nonmodifiable risk factors among both the CA and MT groups. Conclusions Nearly one in six patients with HF is readmitted within 30‐days after undergoing CA. In propensity matched analyses, CA was associated with decreased rate and risk for readmission compared to MT. CA has higher index hospitalization costs, but lower readmission costs.

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Section: Discussionmentioning

confidence: 99%

Thirty‐day readmissions after atrial fibrillation catheter ablation in patients with heart failure

Lima

Kennedy

Sheikh

et al. 2020

Pacing Clinical Electrophis

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“…It is notable that, despite advances in the catheter ablation technologies and increased operator experience year by year, AF ablation procedurerelated complications and mortality have been rather increasing. 13,14 The presence of HF is associated with increases in the mortality and procedural complications. 13,14 Therefore, we still should pursue a better technology for catheter ablation of AF in patients with HF even though catheter ablation of AF in patients with HF has been thought to be highly safe based on studies from highly experienced centers.…”

Section: Impact Of the Difference In The Procedures Process And Lesimentioning

confidence: 99%

“…13,14 The presence of HF is associated with increases in the mortality and procedural complications. 13,14 Therefore, we still should pursue a better technology for catheter ablation of AF in patients with HF even though catheter ablation of AF in patients with HF has been thought to be highly safe based on studies from highly experienced centers. [4][5][6][7][8] Regarding the safety, Chun et al found that the risk of cardiac tamponade is lower in CB ablation of AF than RF ablation, although the total complication risk including phrenic nerve palsy is higher in CB ablation.…”

Section: Impact Of the Difference In The Procedures Process And Lesimentioning

confidence: 99%

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A multicenter study comparing the outcome of catheter ablation of atrial fibrillation between cryoballoon and radiofrequency ablation in patients with heart failure (CRABL‐HF): Study design

Miyamoto

Hasegawa

Takahashi

et al. 2020

Journal of Arrhythmia

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Background: Catheter ablation of atrial fibrillation (AF) is increasingly performed worldwide in patients with heart failure (HF). However, it has been recently emphasized that AF ablation in patients with HF is associated with increased risks of procedure-related complications and mortality. There are little data about the differences in the efficacy and safety between cryoballoon (CB) and radiofrequency (RF) ablation of AF in patients with HF. Methods:The CRABL-HF study is designed as a prospective, multicenter, open-label, controlled, and randomized clinical trial comparing the efficacy and safety of AF ablation between CB and RF ablation in patients with HF (LVEF ≤40%) (UMIN Clinical Trials Registry UMIN000032433). The CRABL-HF study will consist of 110 patients at multicenter in Japan. The patients will be registered and randomly assigned to either the CB ablation or RF ablation group with a 1:1 allocation. The primary endpoint of this study is the occurrence of atrial tachyarrhythmias (ATs) at 1 year with a blanking period of 90 days after ablation. Key secondary endpoints are the success rate of the pulmonary vein isolation, total procedural time, left atrial dwelling time, total fluoroscopy time, radiation exposure, complication rate, composite of all-cause mortality or HF hospitalizations, cardiovascular events, change in left ventricular ejection fraction, and change in quality of life. Results:The results of this study are currently under investigation. Conclusion:The CRABL-HF study is being conducted to compare the efficacy and safety of catheter ablation of AF between CB and RF ablation in patients with HF.

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“…Concurrent use of intra-aortic balloon pump and percutaneous left ventricular assist devices were identi ed with ICD-9-CM procedure codes 37.61 and 37.68, respectively. Since NRD prohibits linking patients across years, patients whose index hospitalization was in December were excluded to allow for completeness of data on 30 days of follow-up after discharge as has been done in prior studies examining the NRD [11][12][13].…”

Section: Study Population and Variablesmentioning

confidence: 99%

Thirty-Day Readmission Rates After Takotsubo Syndrome With or Without Malignancy: A Nationwide Readmissions Database Analysis

Jang

Yeo

Jonas

et al. 2020

Preprint

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Background: Association of malignancy with readmission after TTS hospitalization has not been fully described. We sought to examine the rates, cause and cost of 30-day readmissions and 30-day all-cause mortality of Takotsubo syndrome (TTS) patients with or without malignancy. Methods: The Nationwide Readmissions Databases from 2010 to 2014 were queried to identify and compare baseline characteristics and outcomes of patients hospitalized for TTS with and without malignancy. Results: We identified 61,588 index hospitalizations for TTS. TTS patients with malignancy were older (70.6 ± 0.2 vs. 66.1 ± 0.1, p < 0.001), and the overall burden of comorbidities was higher than in those without malignancy. TTS patients with malignancy had significantly higher 30-day readmission rates than those without malignancy (15.9% vs. 11.0%; odds ratio [OR], 1.35; 95% confidence interval [CI], 1.18 - 1.56). Majority (75.5%) of the etiologies for readmissions were non-cardiac, with infection being most common (20.1%). The 30-day readmission rate due to the recurrent TTS was similar in both groups (0.4% and 0.5%, respectively; p = 0.47). Importantly, 30-day all-cause mortality was higher in TTS with vs. without malignancy (4.8% vs 2.5%; OR, 1.62; 95% CI, 1.25 - 2.10). The total costs (index admission + readmission) were higher by 25% (p < 0.001) in TTS patients with malignancy vs. without malignancy. Conclusions: In patients hospitalized with TTS, the presence of malignancy was associated with increased risk of 30-day readmission, mostly attributable to non-cardiac etiologies. Importantly, the 30-day all-cause mortality and cost were also significantly higher. These findings highlight the importance of optimization of treatment and follow up in patients with malignancy after hospitalizations for TTS.

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Risk of Mortality Following Catheter Ablation of Atrial Fibrillation

Cited by 110 publications

References 19 publications

Thirty‐day readmissions after atrial fibrillation catheter ablation in patients with heart failure

Thirty‐day readmissions after atrial fibrillation catheter ablation in patients with heart failure

A multicenter study comparing the outcome of catheter ablation of atrial fibrillation between cryoballoon and radiofrequency ablation in patients with heart failure (CRABL‐HF): Study design

Thirty-Day Readmission Rates After Takotsubo Syndrome With or Without Malignancy: A Nationwide Readmissions Database Analysis

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