The impact of hospital case volume on the outcomes after catheter ablation for atrial fibrillation according to the ablation technology

Abstract

Introduction:The appropriate hospital case volume for catheter ablation (CA) in patients with atrial fibrillation (AF) according to the ablation technology has not been fully examined. This study aimed to investigate the association between the hospital case volume for AF and periprocedural complications and AF recurrence. Methods: In this retrospective cohort study, we used data from the National Database of Health Insurance Claims and Specific Health Checkups, which covers almost all healthcare insurance claims data in Japan. We included patients with AF who underwent first-time CA from April 2014 to March 2020. Using mixed-effect logistic regression, we analyzed the effect of the annual case volume for AF ablation on acute periprocedural complications and 1-year success rate off antiarrhythmic drugs according to the ablation technology (radiofrequency ablation or cryoballoon ablation).Results: Among 270 116 patients, 207 839 (77%) patients underwent radiofrequency ablation and 56 648 (21%) patients underwent cryoballoon ablation. Of all patients, acute complications occurred in 5411 (2.0%) patients, and the recurrence at 1 year was 71 511 (27%). In the radiofrequency ablation group, acute complications and 1-year AF recurrence according to case volume decreased as the annual case volume increased to up to 150−200 cases/year. However, in the cryoballoon ablation group, these outcomes were similar regardless of the case volumes. Conclusion:The case-volume effect was noted in the radiofrequency ablation group, but not in the cryoballoon ablation group. Our results may affect the selection of ablation technology, especially in smaller case-volume hospitals.

Procedural Volume and Outcomes with Atrial Fibrillation Ablation: A Report from the NCDR AFib Ablation Registry

“…Recently published data from Japan's national database of healthcare insurance claims from 2014 to 2020 involving more than 270,000 de-novo AF ablations, showed an acute complication rate of 2%, similar to our study and acute procedural complications decreased significantly when hospital procedural volume approached 150-200/year. Interestingly, this volume-outcome effect was seen only for radiofrequency ablation, but not for cryoablation 23 . In our study, we did not stratify by ablation energy source as this was not an available variable in the registry, but this attenuated volume-outcome relationship with cryoablation may be due to less procedural and patient complexity and a potentially faster learning curve for hospital staff and physicians.…”

“…The optimal procedural volumes for hospitals and physicians are not clear, and various studies have suggested volume thresholds for hospitals and physicians of 100-200 and 25-100 per year, respectively 11,12,17,19,20,22,23 . Based on our current study, hospitals and physicians performing approximately 190 and 60 annual cases, respectively, are likely to contribute to consistently high procedural success (>98%) and safety (MAE <1%).…”

“…Adjusting for cumulative procedure volume in general did not change the association between annualized procedure volume and outcomes with the exception that at high cumulative hospital volume did seem to attenuate the effect somewhat. The optimal procedural volumes for hospitals and physicians are not clear, and various studies have suggested volume thresholds for hospitals and physicians of 100-200 and 25-100 per year, respectively 11,12,17,19,20,22,23 . Based on our current study, hospitals and physicians performing approximately 190 and 60 annual cases, respectively, are likely to contribute to consistently high procedural success (>98%) and safety (MAE <1%).…”