Death related to procedural complications of AF ablation rare
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Key takeaways:
- The rate of death in the 90 days after atrial fibrillation ablation was 0.22%.
- Only about one-quarter of that was related to procedural complications.
Death associated with atrial fibrillation ablation occurred at a rate of 0.06% among patients treated at several Mayo Clinic locations, according to a large retrospective analysis published in Circulation: Arrhythmia and Electrophysiology.
“The incidence of periprocedural complications of AF ablation was reported to be 2.9% to 5%, and early mortality based on nationwide registry studies involving diagnostic codes ranged from 0.12% to 0.46%,” Min Choon Tan, MD, researcher in the department of cardiovascular medicine at Mayo Clinic in Phoenix, and colleagues wrote. “However, registry-based studies are not able to identify causes of death, especially on the relationship of death to the AF ablation procedure. Critical appraisal of the cause of early mortality is crucial to improving interventions and minimizing the risks of these rare but catastrophic outcomes.”
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Tan and colleagues retrospectively analyzed AF ablations performed at Mayo Clinic campuses in Rochester, Minnesota; Phoenix; and Jacksonville, Florida, from 2013 to Dec. 1, 2021, and they conducted a review of the Mayo Clinic Enterprise Heart Rhythm Practice and outside records to identify patient cause of death.
A total of 6,723 patients were included in this analysis (mean age, 63 years; 31.7% women).
Overall, the 90-day all-cause mortality rate after AF ablation was 0.22%, of which 73.3% did not have a direct relationship with the ablation procedure, according to the study.
The most common causes of death included sudden cardiac death (20%), followed by periprocedural stroke (13%), respiratory failure (13%), atrioesophageal fistula (13%), infection (7%), HF (7%) and traumatic brain injury (7%).
Tan and colleagues reported that the actual 90-day rate of mortality due to AF ablation procedural complications was 0.06%, translating to approximately 26% of all early mortality after the procedure.
“The main advantage of this study over existing publications on 90-day mortality after AF ablation is that this is only study that was performed with comprehensive chart reviews in detailed electronic medical records of three cohorts of patients across the United States (Minnesota, Arizona and Florida). This overcomes the limitation of multicenter registry studies where adjudication of the cause of mortality may not be accurate,” the researchers wrote. “The majority (73.3%) of early mortality was not directly associated with a procedural complication, and the mortality rate due to complications associated with the AF ablation procedure was 0.06%. Further studies are required to investigate causes and risk factors associated with sudden death in this patient population.”
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