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Periprocedural complications, arrhythmia rehospitalizations common in AF ablation
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Among a large cohort of patients undergoing atrial fibrillation ablation, approximately one in 20 patients experienced a periprocedural complication and nearly one in 10 were rehospitalized within 30 days, according to recent study results.
By searching the California State Inpatient Database, researchers identified 4,156 patients (mean age=61.7 years) who underwent an initial AF ablation procedure from 2005 to 2008. Researchers used multivariable logistic regression and Kaplan-Meier analysis to identify predictors of complications or 30-day readmissions and rates of all-cause and arrhythmia-related readmissions.
Overall, 5% of patients experienced periprocedural complications and 9% were readmitted within 30 days, according to study results. Researchers found that 9.4% of patients discharged were rehospitalized within 30 days of index hospitalization, with 26.9% of readmission caused by AF or atrial flutter and 19.5% from procedural complications. Of all vascular complications, bleeding-related events accounted for more than half of all complications.
Study results showed an association with higher adjusted risk for complications or 30-day readmission among:
- Older aged patients.
- Women.
- Patients with prior AF hospitalizations.
- Less hospital experience with AF ablation.
By 1 year, the rate of all-cause hospitalizations was 38.5% and the rate of readmission for recurrent AF, atrial flutter or repeat ablation was 21.7% at 1 year and 29.6% at 2 years.
More than 1,800 patients were readmitted after AF ablation for any reason in long-term follow-up, and by 1 year, 61.5% of patients were free of hospital admission (95% CI, 59.9-63.1), according to study data. Rehospitalization for arrhythmia recurrence or repeat ablation occurred in 1,022 patients, but by 1 year, 78.3% (95% CI, 76.9-79.6) of patients were free of readmission for recurrent arrhythmia or repeat ablation. However, by 2 years, this rate decreased to 70.4% (95% CI, 68.7-72). The researchers also found that 17.4% of all study patients received an additional ablation.
According to David E. Haines, MD, of the department of CV medicine at Oakland University William Beaumont School of Medicine, the real-world success rate of AF ablation is unknown, but it is likely lower than results from single-center studies show. Also, he said complication and hospitalization rates are significant, demonstrating that operator and hospital procedure volume are inversely correlated with poor outcomes.
“It is imperative that any center that commits to establishing an AF ablation program initiates robust quality assurance methodology that tracks the long-term outcomes after intervention,” Haines wrote in an accompanying editorial. “Until this is done, it is impossible to understand whether the individual operators and the hospital team are providing acceptable service to their patients.”
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Ablation of AF is a challenging procedure that requires the utmost skills, both intellectual and technical. In experienced hands, depending on the type of AF, initial success rates can be as high as 85%. As with virtually all procedures in medicine, high-volume centers attain higher success rates with fewer complications. It may be time to consider restricting this procedure to certain centers with demonstrated skill sets.
– Douglas P. Zipes, MD
Cardiology Today Section Editor
Disclosure: Dr. Zipes reports no relevant financial disclosures.
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