Background
Predictors of complications from atrial fibrillation (AF) ablation have been identified
in small studies. The combination of risk factors to predict complications after ablation
has not yet been explored.
Objective
The purpose of this study was to develop a risk score model that predicts complications
after AF ablation.
Methods
The National Inpatient Sample database was used to identify 106,105 patients who underwent
AF ablation. The study population was split into derivation cohort (DC; 2007–2010;
n = 56,658) and validation cohort (VC; 2011–2013; n = 49,447). The multivariate predictors
of any complication were identified in DC using regression analysis, and a risk score
model was developed. The cohorts were divided into 5 groups (risk score in parentheses):
group 0 (0), group 1 (1–10), group 2 (11–20), group 3 (21–30), and group 4 (31–61).
Results
Patients in VC were older, likely to be white, female and had a higher prevalence
of comorbidities. The overall complication rate (6.9% vs 8.3%; P < .0001) and inhospital mortality rate (0.3% vs 0.5%; P < .0001) were lower in VC than in DC. A multivariate analysis yielded 9 predictors
for any complication (weightage points in parentheses): cerebrovascular accident (19),
congestive heart failure (12), coagulopathy (11), renal failure (7), peripheral vascular
disease (6), age ≥50 years (2), female sex (2), chronic obstructive lung disease (1),
and nonwhite (1). In the overall cohort, the risk of complications in groups 0, 1,
2, 3, and 4 was 3.6%, 6.5%, 15.5%, 29.5%, and 45.7%, respectively, and inhospital
mortality was 0%, 0.2%, 2%, 4.6%, and 6.1%, respectively. Similar trends were observed
in DC and VC.
Conclusion
A practical risk score model can be used preoperatively to risk stratify patients
undergoing AF ablation.
Graphical abstract
Graphical Abstract
Keywords
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References
- Complications of catheter ablation for atrial fibrillation: incidence and predictors.J Cardiovasc Electrophysiol. 2008; 19: 627-631
- Complications of atrial fibrillation ablation in a high-volume center in 1,000 procedures: still cause for concern?.J Cardiovasc Electrophysiol. 2009; 20: 1014-1019
- Trends in utilization and complications of catheter ablation for atrial fibrillation in Medicare beneficiaries.Heart Rhythm. 2009; 6: 1267-1273
- Prevalence and predictors of complications of radiofrequency catheter ablation for atrial fibrillation.J Cardiovasc Electrophysiol. 2011; 22: 626-631
- Complications arising from catheter ablation of atrial fibrillation: temporal trends and predictors.Heart Rhythm. 2011; 8: 1869-1874
- Low risk of major complications associated with pulmonary vein antral isolation for atrial fibrillation: results of 500 consecutive ablation procedures in patients with low prevalence of structural heart disease from a single center.J Cardiovasc Electrophysiol. 2011; 22: 163-168
- Outcomes of Medicare beneficiaries undergoing catheter ablation for atrial fibrillation.Circulation. 2012; 126: 2200-2207
- Procedural complications, rehospitalizations, and repeat procedures after catheter ablation for atrial fibrillation.J Am Coll Cardiol. 2012; 59: 143-149
- In-hospital complications associated with catheter ablation of atrial fibrillation in the United States between 2000 and 2010: analysis of 93 801 procedures.Circulation. 2013; 128: 2104-2112
- 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society.Circulation. 2014; 130: e199-e267
- Healthcare Cost and Utilization Project (HCUP) Web site.(Accessed August 29, 2016)
- Development and validation of a risk score for predicting death in Chagas' heart disease.N Engl J Med. 2006; 355: 799-808
- What do we mean by validating a prognostic model?.Stat Med. 2000; 19: 453-473
- Periprocedural stroke and management of major bleeding complications in patients undergoing catheter ablation of atrial fibrillation: the impact of periprocedural therapeutic international normalized ratio.Circulation. 2010; 121: 2550-2556
- Prevalence and causes of fatal outcome in catheter ablation of atrial fibrillation.J Am Coll Cardiol. 2009; 53: 1798-1803
- Delayed rhythm control of atrial fibrillation may be a cause of failure to prevent recurrences: reasons for change to active antiarrhythmic treatment at the time of the first detected episode.Europace. 2008; 10: 21-27
- Progression from paroxysmal to persistent atrial fibrillation clinical correlates and prognosis.J Am Coll Cardiol. 2010; 55: 725-731
- Rationale and current perspective for early rhythm control therapy in atrial fibrillation.Europace. 2011; 13: 1517-1525
- Feasibility and safety of outpatient radiofrequency catheter ablation procedures for atrial fibrillation.Postgrad Med J. 2010; 86: 395-398
Article info
Publication history
Published online: May 04, 2017
Footnotes
The first 2 authors contributed equally to this work.
Dr Ellenbogen has received honoraria, consulting fees, and research support from AtriCure, Biosense Webster, Medtronic, Boston Scientific, and St. Jude Medical.
Identification
Copyright
© 2017 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
