Temporal trends of in-hospital complications associated with catheter ablation of atrial fibrillation in the United States: An update from Nationwide Inpatient Sample database (2011-2014)

Byomesh Tripathi, Shilpkumar Arora, Varun Kumar, Mohamed Abdelrahman, Sopan Lahewala, Mihir Dave, Mahek Shah, Bryan Tan, Sejal Savani, Apurva Badheka, Radha Gopalan, Ghanshyam Palamaner Subash Shantha, Juan Viles Gonzalez, Abhishek Deshmukh

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background: Catheter ablation is widely accepted intervention for atrial fibrillation (AF) refractory to antiarrhythmic drugs, but limited data are available regarding contemporary trends in major complications and in-hospital mortality due to the procedure. This study was aimed at exploring the temporal trends of in-hospital mortality, major complications, and impact of hospital volume on frequency of AF ablation-related outcomes. Methods: The Nationwide Inpatient Sample database was utilized to identify the AF patients treated with catheter ablation. In-hospital death and common complications including vascular access complications, cardiac perforation and/or tamponade, pneumothorax, stroke, and transient ischemic attack, were identified using International Classification of Disease (ICD-9-CM) codes. Result: In-hospital mortality rate of 0.15% and overall complication rate of 5.46% were noted among AF ablation recipients (n = 50,969). Significant increase in complications during study period (relative increase 56.37%, P-trend < 0.001) was observed. Cardiac (2.65%), vascular (1.33%), and neurological (1.05%) complications were most common. On multivariate analysis (odds ratio [OR]; 95% confidence interval [95% CI]; P value), significant predictors of complications were female sex (OR = 1.40; CI = 1.17-1.68; P value < 0.001), high burden of comorbidity as indicated by Charlson Comorbidity Index ≥2 (OR = 2.84; CI = 2.29-3.52; P value < 0.001), and low hospital volume (< 50 procedures). Conclusion: Our study noted a decline in AF ablation-related hospitalizations and complications associated with the procedure. These findings largely reflect shifting trends of outpatient performance of the procedure and increasing safety profile due to improved institutional expertise and catheter techniques.

Original languageEnglish (US)
JournalJournal of Cardiovascular Electrophysiology
DOIs
StateAccepted/In press - Jan 1 2018

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Catheter Ablation
Atrial Fibrillation
Inpatients
Databases
Hospital Mortality
Odds Ratio
International Classification of Diseases
Blood Vessels
Comorbidity
Low-Volume Hospitals
Anti-Arrhythmia Agents
Transient Ischemic Attack
Sex Ratio
Pneumothorax
Hospitalization
Outpatients
Multivariate Analysis
Catheters
Stroke
Confidence Intervals

Keywords

  • Ablation
  • Atrial fibrillation
  • Catheter ablation
  • Complications
  • Radiofrequency
  • Trends

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Temporal trends of in-hospital complications associated with catheter ablation of atrial fibrillation in the United States : An update from Nationwide Inpatient Sample database (2011-2014). / Tripathi, Byomesh; Arora, Shilpkumar; Kumar, Varun; Abdelrahman, Mohamed; Lahewala, Sopan; Dave, Mihir; Shah, Mahek; Tan, Bryan; Savani, Sejal; Badheka, Apurva; Gopalan, Radha; Shantha, Ghanshyam Palamaner Subash; Viles Gonzalez, Juan; Deshmukh, Abhishek.

In: Journal of Cardiovascular Electrophysiology, 01.01.2018.

Research output: Contribution to journalArticle

Tripathi, B, Arora, S, Kumar, V, Abdelrahman, M, Lahewala, S, Dave, M, Shah, M, Tan, B, Savani, S, Badheka, A, Gopalan, R, Shantha, GPS, Viles Gonzalez, J & Deshmukh, A 2018, 'Temporal trends of in-hospital complications associated with catheter ablation of atrial fibrillation in the United States: An update from Nationwide Inpatient Sample database (2011-2014)', Journal of Cardiovascular Electrophysiology. https://doi.org/10.1111/jce.13471
Tripathi, Byomesh ; Arora, Shilpkumar ; Kumar, Varun ; Abdelrahman, Mohamed ; Lahewala, Sopan ; Dave, Mihir ; Shah, Mahek ; Tan, Bryan ; Savani, Sejal ; Badheka, Apurva ; Gopalan, Radha ; Shantha, Ghanshyam Palamaner Subash ; Viles Gonzalez, Juan ; Deshmukh, Abhishek. / Temporal trends of in-hospital complications associated with catheter ablation of atrial fibrillation in the United States : An update from Nationwide Inpatient Sample database (2011-2014). In: Journal of Cardiovascular Electrophysiology. 2018.
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abstract = "Background: Catheter ablation is widely accepted intervention for atrial fibrillation (AF) refractory to antiarrhythmic drugs, but limited data are available regarding contemporary trends in major complications and in-hospital mortality due to the procedure. This study was aimed at exploring the temporal trends of in-hospital mortality, major complications, and impact of hospital volume on frequency of AF ablation-related outcomes. Methods: The Nationwide Inpatient Sample database was utilized to identify the AF patients treated with catheter ablation. In-hospital death and common complications including vascular access complications, cardiac perforation and/or tamponade, pneumothorax, stroke, and transient ischemic attack, were identified using International Classification of Disease (ICD-9-CM) codes. Result: In-hospital mortality rate of 0.15{\%} and overall complication rate of 5.46{\%} were noted among AF ablation recipients (n = 50,969). Significant increase in complications during study period (relative increase 56.37{\%}, P-trend < 0.001) was observed. Cardiac (2.65{\%}), vascular (1.33{\%}), and neurological (1.05{\%}) complications were most common. On multivariate analysis (odds ratio [OR]; 95{\%} confidence interval [95{\%} CI]; P value), significant predictors of complications were female sex (OR = 1.40; CI = 1.17-1.68; P value < 0.001), high burden of comorbidity as indicated by Charlson Comorbidity Index ≥2 (OR = 2.84; CI = 2.29-3.52; P value < 0.001), and low hospital volume (< 50 procedures). Conclusion: Our study noted a decline in AF ablation-related hospitalizations and complications associated with the procedure. These findings largely reflect shifting trends of outpatient performance of the procedure and increasing safety profile due to improved institutional expertise and catheter techniques.",
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T1 - Temporal trends of in-hospital complications associated with catheter ablation of atrial fibrillation in the United States

T2 - An update from Nationwide Inpatient Sample database (2011-2014)

AU - Tripathi, Byomesh

AU - Arora, Shilpkumar

AU - Kumar, Varun

AU - Abdelrahman, Mohamed

AU - Lahewala, Sopan

AU - Dave, Mihir

AU - Shah, Mahek

AU - Tan, Bryan

AU - Savani, Sejal

AU - Badheka, Apurva

AU - Gopalan, Radha

AU - Shantha, Ghanshyam Palamaner Subash

AU - Viles Gonzalez, Juan

AU - Deshmukh, Abhishek

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Catheter ablation is widely accepted intervention for atrial fibrillation (AF) refractory to antiarrhythmic drugs, but limited data are available regarding contemporary trends in major complications and in-hospital mortality due to the procedure. This study was aimed at exploring the temporal trends of in-hospital mortality, major complications, and impact of hospital volume on frequency of AF ablation-related outcomes. Methods: The Nationwide Inpatient Sample database was utilized to identify the AF patients treated with catheter ablation. In-hospital death and common complications including vascular access complications, cardiac perforation and/or tamponade, pneumothorax, stroke, and transient ischemic attack, were identified using International Classification of Disease (ICD-9-CM) codes. Result: In-hospital mortality rate of 0.15% and overall complication rate of 5.46% were noted among AF ablation recipients (n = 50,969). Significant increase in complications during study period (relative increase 56.37%, P-trend < 0.001) was observed. Cardiac (2.65%), vascular (1.33%), and neurological (1.05%) complications were most common. On multivariate analysis (odds ratio [OR]; 95% confidence interval [95% CI]; P value), significant predictors of complications were female sex (OR = 1.40; CI = 1.17-1.68; P value < 0.001), high burden of comorbidity as indicated by Charlson Comorbidity Index ≥2 (OR = 2.84; CI = 2.29-3.52; P value < 0.001), and low hospital volume (< 50 procedures). Conclusion: Our study noted a decline in AF ablation-related hospitalizations and complications associated with the procedure. These findings largely reflect shifting trends of outpatient performance of the procedure and increasing safety profile due to improved institutional expertise and catheter techniques.

AB - Background: Catheter ablation is widely accepted intervention for atrial fibrillation (AF) refractory to antiarrhythmic drugs, but limited data are available regarding contemporary trends in major complications and in-hospital mortality due to the procedure. This study was aimed at exploring the temporal trends of in-hospital mortality, major complications, and impact of hospital volume on frequency of AF ablation-related outcomes. Methods: The Nationwide Inpatient Sample database was utilized to identify the AF patients treated with catheter ablation. In-hospital death and common complications including vascular access complications, cardiac perforation and/or tamponade, pneumothorax, stroke, and transient ischemic attack, were identified using International Classification of Disease (ICD-9-CM) codes. Result: In-hospital mortality rate of 0.15% and overall complication rate of 5.46% were noted among AF ablation recipients (n = 50,969). Significant increase in complications during study period (relative increase 56.37%, P-trend < 0.001) was observed. Cardiac (2.65%), vascular (1.33%), and neurological (1.05%) complications were most common. On multivariate analysis (odds ratio [OR]; 95% confidence interval [95% CI]; P value), significant predictors of complications were female sex (OR = 1.40; CI = 1.17-1.68; P value < 0.001), high burden of comorbidity as indicated by Charlson Comorbidity Index ≥2 (OR = 2.84; CI = 2.29-3.52; P value < 0.001), and low hospital volume (< 50 procedures). Conclusion: Our study noted a decline in AF ablation-related hospitalizations and complications associated with the procedure. These findings largely reflect shifting trends of outpatient performance of the procedure and increasing safety profile due to improved institutional expertise and catheter techniques.

KW - Ablation

KW - Atrial fibrillation

KW - Catheter ablation

KW - Complications

KW - Radiofrequency

KW - Trends

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