Safety and complications of catheter ablation for atrial fibrillation: Predictors of complications from an updated analysis the National Inpatient Database

Abstract

Background Catheter ablation is increasingly employed in the management of atrial fibrillation (AF). Data regarding safety of ablation of AF is largely derived from controlled clinical trials. Objectives The aim of this study was to analyze safety and complications of AF ablation performed in a “real world” setting outside of clinical trials, and obtain insights on predictors of complications. Methods We utilized the National Inpatient Sample database, to identify all patients who underwent AF ablations between 2015 and 2017 using International Classification of Disease—Tenth revision codes. Complications were defined as per the Agency for Health Care Research and Quality Guidelines. Statistical tests including multivariate logistic regression were performed to determine predictors of complications. Results Among 14,875 cases of AF ablation between 2015 and 2017, a total of 1884 complications were identified among 1080 (7.2%) patients. Patients with complications were likely to be older and female with a higher burden of comorbidities. A 27% increase in complications was observed from 2015 to 2017, driven by an increase in pericardial complications. Multivariate regression analysis revealed that pulmonary hypertension (adjusted odds ratio [aOR]: 1.99, p = .041) and chronic kidney disease (CKD; aOR: 1.67, p = .024), were independent predictors of complications. Centers with higher procedural volumes were associated with lower complication rates. Conclusions Complication rates related to AF ablations remain substantially high. Presence of pulmonary hypertension and CKD are predictive of higher procedural complications. Furthermore, hospital procedure volume is an important factor that correlates with complication rates.

Temporal trends and in‐hospital complications of catheter ablation for atrial fibrillation among patients with moderate and advanced chronic kidney diseases: 2005−2018

“…Regarding a safety perspective, our results were drastically contrasted to one previous study 10 . The study showed no difference in postprocedural complications in both patients with and without CKD, as opposed to our analysis and the recent study by Wu et al 18 Nevertheless, inclusion criteria for CKD in this previous study were not classified by CKD stages in which heterogeneity within its group is of particular concern. Hence, this may not fully explain the actual impact of CKD on AF ablation.…”

Atrial fibrillation ablation in chronic kidney disease—Lessons from large datasets

“…The findings in this study are consistent with another recent NIS study examining complications after AF ablation for recent years (where CKD was an independent predictor of complications), 7 but differ slightly from another database study 8 . Besides a different time period of analysis, the study by Ullal et al used a claims database (and therefore different methodology for identifying 30‐day complications); in fact, that study did find a higher rate of blood transfusions in the CKD group, although it did not translate to a higher overall complicate rate.…”

One year outcomes of atrial fibrillation ablation: Contemporary analysis of the United States Nationwide Readmission Database

“…26 In our current study, AF ablation was associated with increased rates of cardiopulmonary resuscitation and need for mechanical ventilation compared to controls, and our previous study showed a significantly increasing trend of CA-related complications. 8 As AF ablation is being increasingly performed in older and sicker patients, the risks of ablation should also be taken into consideration when treating AF with CA.…”

“…Previously, we reported safety profile and complications of AF ablation derived from our analysis of the National Inpatient Sample (NIS) database which is the largest publicly available all-payer inpatient health care database in the United States. 8 In this study, we leverage the Nationwide Readmissions Database (NRD), which has been studied and validated in multiple previous studies. 9 We followed a comparative model of propensity matched controls to assess the efficacy of CA for AF primarily in terms of unplanned HF, AF, and stroke-related readmissions at 1 year as well as mortality.…”

“…Thus, data on long‐term efficacy and outcomes of AF ablation especially among patients with HF outside of RCT settings are sparse. Previously, we reported safety profile and complications of AF ablation derived from our analysis of the National Inpatient Sample (NIS) database which is the largest publicly available all‐payer inpatient health care database in the United States 8 . In this study, we leverage the Nationwide Readmissions Database (NRD), which has been studied and validated in multiple previous studies 9 .…”