Background
Rates of early mortality and complications after catheter ablation (CA) of atrial
fibrillation (AF) vary across health care settings.
Objective
The purpose of this study was to identify the rate and predictors of early mortality
(within 30 days) after CA in the inpatient and outpatient settings.
Methods
Using the Medicare Fee for Service database, we analyzed 122,289 patients who underwent
CA for treatment of AF between 2016 and 2019 to define 30-day mortality in both inpatients
and outpatients. Odds of adjusted mortality were assessed with several methods, including
inverse probability of treatment weighting.
Results
Mean age was 71.9 ± 6.7 years, 44% were women, and mean CHA2DS2-VASc score was 3.2 ± 1.7. Overall, 82% underwent AF ablation as an outpatient. Mortality
rate 30 days after CA was 0.6%, with inpatients accounting for 71.5% of deaths (P <.001). Early mortality rates were 0.2% for outpatient procedures and 2.4% for inpatient
procedures. The prevalence of comorbidities was significantly higher in patients with
early mortality. Patients with early mortality had significantly higher rates of postprocedural
complications. After adjustment, inpatient ablation was significantly associated with
early mortality (adjusted odds ratio [aOR] 3.81; 95% confidence interval [CI] 2.87–5.08;
P <.001). Hospitals with high overall ablation volume had 31% lower odds of early mortality
(highest vs lowest tertile: aOR 0.69; 95% CI 0.56–0.86; P <.001).
Conclusion
AF ablation conducted in the inpatient setting is associated with a higher rate of
early mortality compared with outpatient AF ablation. Comorbidities are associated
with enhanced risk of early mortality. High overall ablation volume is associated
with a lower risk of early mortality.
Keywords
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Article info
Publication history
Published online: February 20, 2023
Publication stage
In Press Journal Pre-ProofFootnotes
Funding Sources: Funding for this analysis was provided by Medtronic. Disclosures: Dr Piccini is supported by R01HL128595 from the National Heart, Lung, and Blood Institute and R01AG074185 from the National Institutes of Aging; receives grants for clinical research from Abbott, American Heart Association, Association for the Advancement of Medical Instrumentation, Bayer, Boston Scientific, iRhythm, and Philips; and serves as a consultant to Abbott, Abbvie, Ablacon, Altathera, ARCA Biopharma, Biotronik, Boston Scientific, Bristol Myers Squibb, LivaNova, Medtronic, Milestone, ElectroPhysiology Frontiers, Pfizer, Sanofi, Philips, and Up-to-Date. Alicia Sale and Colleen Longacre are employed by Medtronic. Jiani Zhou is an employee of Medtronic and is a PhD candidate of the University of Minnesota, Twin Cities. Dr Zeitler receives a research grant from Boston Scientific; serves as a consultant and speaker for Medtronic Inc., Boston Scientific, Biosense Webster, Arena (Pfizer), and EchoIQ; receives travel support from Medtronic Inc.; and receives research support from Biosense Webster and Sanofi. Dr Andrade receives consulting fees and honoraria from Bayer, Bristol Myers Squibb–Pfizer Alliance, Servier, and Medtronic; and receives research grants from Medtronic and Baylis. Dr Mittal serves as a consultant for Boston Scientific, Medtronic, and Philips. Dr Obeid reports no relevant disclosures.
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© 2023 Published by Elsevier Inc. on behalf of Heart Rhythm Society.
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- Mortality of ablation of atrial fibrillation: 25 Years later, still too risky for too manyHeart Rhythm
- PreviewOn this year’s 25th anniversary of the landmark report1 on ablation of pulmonary vein ectopy initiating atrial fibrillation (AF), which preceded by 1 year ablation of AF using nonfluoroscopic 3-dimensional mapping,2 we are reminded how both approaches would forever transform cardiac electrophysiology as a predominant diagnostic discipline, also performing device implantation and ablation of supraventricular tachycardia to become a therapeutic catheter ablation interventional specialty. Clinical cardiac electrophysiologists were somewhat unprepared or caught off guard a few years later when atrioesophageal fistulas, associated with significant morbidity and mortality, were first reported as a complication of ablation of AF.
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