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AF ablation volume correlated with complication, mortality rates
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SAN FRANCISCO — Patients who receive atrial fibrillation ablation at hospitals that perform the procedures infrequently are at elevated risk for complications and mortality, according to findings presented at the Heart Rhythm Society Annual Scientific Sessions.
Jim W. Cheung, MD, FHRS, and colleagues analyzed the relationship between catheter ablation of AF stratified by hospital volume using a national administrative database.
“Our research group has always been interested in understanding the impact of institutional procedure volume on outcomes after cardiovascular procedures, and so we wanted to explore its significance with AF catheter ablation procedures,” Cheung, an associate professor of medicine and the director of clinical electrophysiology research at NewYork-Presbyterian Hospital, told Cardiology Today. “By better understanding the distribution of annual AF ablation hospital volume across the nation and the association between volume and outcomes, we may be able to provide guidance for considering minimum ablation volume thresholds that may lead to better patient outcomes.”
The researchers examined data from the Nationwide Readmissions Database that included 54,597 admissions for AF ablation between 2010 and 2014. The hospitals were categorized in tertiles based on annual AF ablation volume (1 to 20 per year, 21 to 52 per year or at least 53 per year).
The researchers discerned that between 2010 and 2014, 79% of the hospitals performing AF ablations were in the lower-volume tertile.
Complication rates were greater in the lower-volume tertile compared with the moderate- and high-volume tertiles (8.9% vs. 6.1% vs. 4.5%, respectively; P < .001), the researchers wrote in an abstract.
Lower-volume hospitals were independently associated with increased cardiac perforation (adjusted OR = 4.85; P <.001), vascular complications (aOR = 1.39; P = .002), overall complications (aOR = 2.07; P < .001) and early mortality (aOR = 2.24; P = .015), Cheung and colleagues wrote.
All-cause 30-day readmissions were higher in lower-volume centers compared with moderate- and high-volume centers (13.2% vs. 9.9% vs. 9.3%, respectively; P < .001).
“Development of guidelines on minimum AF ablation volume thresholds may result in improved outcomes,” the researchers wrote in the abstract.
Cheung said the effect of operator volume must be explored as well.
“Our study findings highlight several concerning things, which may have implications for patient referrals for AF ablation and health care policy,” Cheung said. “In addition to operator skill and experience, lower-volume hospitals may have decreased access to equipment, skilled nursing and supporting services that can minimize complications and its associated mortality. This raises the question of whether or not minimal annual volume thresholds for AF ablation should be established or if preferential referral to higher-volume centers would lead to better patient outcomes.” – by Earl Holland Jr.
Reference:
Cheung JW, et al. Abstract S-PO01-123. Presented at: Heart Rhythm Scientific Sessions; May 8-11, 2019; San Francisco.
Disclosure: Cheung reports receiving consultant fees from Abbott and Biotronik and research grant funding from Biotronik.