Higher hospital and physician atrial fibrillation (AFib) ablation procedure volumes were associated with increased acute procedural success and lower rates of major adverse events (MAEs), according to a study published in Heart Rhythm.

Sharma Kattel, MD, PhD, et al., reviewed 70,296 first-time AFib ablations from 186 facilities reported to the ACC’s AFib Ablation Registry between July 2019 and June 2022, investigating the association between hospital and physician procedure volume and procedural success and MAEs. Procedure volumes by hospital and physician were annualized and stratified into quartiles for the analysis.

Procedural success was attained in 98.5% of cases analyzed, and the overall rate of MAEs was 1%. Procedural success rates increased across hospital volume quartiles. The adjusted odds of procedural success when compared to the highest quartile (Q4) were lower in Q1 (odds ratio [OR], 0.44; CI, 0.29-0.68; p=0.0002), Q2 (OR, 0.50; CI, 0.33-0.75; p=0.001) and Q3 (OR, 0.60; CI, 0.40-0.89; p=0.011), with results being similar for physician procedure volume.

MAE rates decreased with increasing hospital volume, and when compared to Q4, the adjusted odds of an MAE was significantly higher for Q1 (OR, 1.78; CI, 1.26-2.52; p=0.001), but not for Q2 (OR, 1.06; CI, 0.77-1.46; p=0.728) or Q3 (OR, 1.19; CI, 0.89-1.58; p=0.249). A statistically significant inverse relationship was noted for physician procedure volume in Q1 and Q2 but not for Q3.

The authors additionally found that "hospitals and physicians performing approximately 190 and 60 annual cases, respectively, are likely to contribute to consistently high procedural success (>98%) and safety (MAE rate <1%)."

"These findings suggest that moderate procedural volumes that are likely to be achievable across a variety of health care systems may be sufficient to maintain the necessary skills of hospital staff and physicians to achieve favorable procedural success and safety," write the authors. "These findings may inform future [AFib] ablation guideline recommendations and hospital and physician practice quality improvement initiatives and establish criteria for [AFib] centers of excellence."

Clinical Topics: Arrhythmias and Clinical EP, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: National Cardiovascular Data Registries, AFib Ablation Registry, Atrial Fibrillation