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Mortality Risk After Catheter Ablation of Atrial Fibrillation
Study Questions:
What is the risk of death associated with catheter ablation (CA) of atrial fibrillation (AF)?
Methods:
The data for this study were obtained from the National Readmissions Database, which collects data from 22 states. There were 60,203 adults who underwent CA of AF. The primary endpoint was early mortality, defined as mortality either during the index ablation hospitalization or during 30-day rehospitalizations.
Results:
The overall mortality rate was 0.46%. Approximately 50% of deaths (54.3%) occurred during the 30-day readmission. The median time to death was 11.6 days. By multivariate analysis, the strongest independent predictors of early mortality were a procedural complication (most often cardiac tamponade; odds ratio [OR], 4.1), heart failure (HF; OR, 2.2), coagulopathy (OR, 2.14), anemia (OR, 1.8), and low ablation volume (<21 AF ablation procedures/year; OR, 2.35).
Conclusions:
The early mortality rate after CA of AF is 0.46%, with approximately 50% of deaths occurring during rehospitalizations within the first 30 days of the index hospitalization. The strongest predictors of early death are a procedural complication and HF, suggesting that early identification and treatment of a complication and HF might decrease the mortality rate.
Perspective:
The mortality rate reported in this study is likely to be an underestimate, because deaths that occurred outside the hospital or in a state other than the one in which the index ablation procedure was performed were not accounted for in the National Readmissions Database. In addition to early identification and treatment of a complication and HF, the data suggest that mortality also could be improved by restricting low-volume hospitals from performing AF CA procedures in the absence of an experienced proctor.
Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Pericardial Disease, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure
Keywords: Anemia, Arrhythmias, Cardiac, Atrial Fibrillation, Cardiac Tamponade, Catheter Ablation, Heart Failure, Hospitals, Low-Volume, Patient Readmission, Risk, Secondary Prevention
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