Research Article|Articles in Press

Early mortality after inpatient versus outpatient catheter ablation in patients with atrial fibrillation

Published:February 20, 2023DOI:


      Rates of early mortality and complications after catheter ablation (CA) of atrial fibrillation (AF) vary across health care settings.


      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.


      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.


      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).


      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.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Heart Rhythm
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • January C.T.
        • Wann L.S.
        • Alpert J.S.
        • et al.
        2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation.
        J Am Coll Cardiol. 2014; 64: e1-e76
        • Mark D.B.
        • Anstrom K.J.
        • Sheng S.
        • et al.
        Effect of catheter ablation vs medical therapy on quality of life among patients with atrial fibrillation: the CABANA randomized clinical trial.
        JAMA. 2019; 321: 1275-1285
        • Prabhu S.
        • Taylor A.J.
        • Costello B.T.
        • et al.
        Catheter ablation versus medical rate control in atrial fibrillation and systolic dysfunction: the CAMERA-MRI study.
        J Am Coll Cardiol. 2017; 70: 1949-1961
        • Marrouche N.F.
        • Brachmann J.
        • Andresen D.
        • et al.
        Catheter ablation for atrial fibrillation with heart failure.
        N Engl J Med. 2018; 378: 417-427
        • Reddy S.A.
        • Nethercott S.L.
        • Chattopadhyay R.
        • Heck P.M.
        • Virdee M.S.
        Safety, feasibility and economic impact of same-day discharge following atrial fibrillation ablation.
        Heart Lung Circ. 2020; 29: 1766-1772
        • Samuel M.
        • Avgil Tsadok M.
        • Joza J.
        • et al.
        Catheter ablation for the treatment of atrial fibrillation is associated with a reduction in health care resource utilization.
        J Cardiovasc Electrophysiol. 2017; 28: 733-741
        • Deshmukh A.
        • Patel N.J.
        • Pant S.
        • et al.
        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
        • Piccini J.P.
        • Sinner M.F.
        • Greiner M.A.
        • et al.
        Outcomes of Medicare beneficiaries undergoing catheter ablation for atrial fibrillation.
        Circulation. 2012; 126: 2200-2207
        • Cappato R.
        • Calkins H.
        • Chen S.A.
        • et al.
        Prevalence and causes of fatal outcome in catheter ablation of atrial fibrillation.
        J Am Coll Cardiol. 2009; 53: 1798-1803
        • Abdur Rehman K.
        • Wazni O.M.
        • Barakat A.F.
        • et al.
        Life-threatening complications of atrial fibrillation ablation: 16-year experience in a large prospective tertiary care cohort.
        JACC Clin Electrophysiol. 2019; 5: 284-291
        • Cheng E.P.
        • Liu C.F.
        • Yeo I.
        • et al.
        Risk of mortality following catheter ablation of atrial fibrillation.
        J Am Coll Cardiol. 2019; 74: 2254-2264
        • Deyell M.W.
        • Leather R.A.
        • Macle L.
        • et al.
        Efficacy and safety of same-day discharge for atrial fibrillation ablation.
        JACC Clin Electrophysiol. 2020; 6: 609-619
        • Friedman D.J.
        • Pokorney S.D.
        • Ghanem A.
        • et al.
        Predictors of cardiac perforation with catheter ablation of atrial fibrillation.
        JACC Clin Electrophysiol. 2020; 6: 636-645
        • Enriquez A.
        • Saenz L.C.
        • Rosso R.
        • et al.
        Use of intracardiac echocardiography in interventional cardiology: working with the anatomy rather than fighting it.
        Circulation. 2018; 137: 2278-2294
        • Cooper J.M.
        • Epstein L.M.
        Use of intracardiac echocardiography to guide ablation of atrial fibrillation.
        Circulation. 2001; 104: 3010-3013
        • Isath A.
        • Padmanabhan D.
        • Haider S.W.
        • et al.
        Does the use of intracardiac echocardiography during atrial fibrillation catheter ablation improve outcomes and cost? A nationwide 14-year analysis from 2001 to 2014.
        J Interv Card Electrophysiol. 2021; 61: 461-468
        • Balakrishnan M.
        • Hutchinson M.D.
        Prevention and early recognition of complications during catheter ablation by intracardiac echocardiography.
        Card Electrophysiol Clin. 2021; 13: 357-364
        • Shah R.U.
        • Freeman J.V.
        • Shilane D.
        • Wang P.J.
        • Go A.S.
        • Hlatky M.A.
        Procedural complications, rehospitalizations, and repeat procedures after catheter ablation for atrial fibrillation.
        J Am Coll Cardiol. 2012; 59: 143-149
        • Cappato R.
        • Calkins H.
        • Chen S.A.
        • et al.
        Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation.
        Circ Arrhythm Electrophysiol. 2010; 3: 32-38
        • Hosseini S.M.
        • Rozen G.
        • Saleh A.
        • et al.
        Catheter ablation for cardiac arrhythmias: utilization and in-hospital complications, 2000 to 2013.
        JACC Clin Electrophysiol. 2017; 3: 1240-1248
        • Voskoboinik A.
        • Sparks P.B.
        • Morton J.B.
        • et al.
        Low rates of major complications for radiofrequency ablation of atrial fibrillation maintained over 14 years: a single centre experience of 2750 consecutive cases.
        Heart Lung Circ. 2018; 27: 976-983

      Linked Article

      • Mortality of ablation of atrial fibrillation: 25 Years later, still too risky for too many
        Heart Rhythm
        • Preview
          On 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.
        • Full-Text
        • PDF