Vratika Agarwal1,2, Neeraj Shah3, Kathan Mehta4, Anand Agarwal5, Jonathan Willner6, James Lafferty6. 1. Department of Cardiovascular Medicine, Staten Island University Hospital, 475 Seaview Ave., New York, 10305, USA. VAgarwal2@northwell.edu. 2. Department of Cardiology, Staten Island University Hospital, 6th floor Heart tower, 475 Seaview Avenue, Staten Island, NY, 10305, USA. VAgarwal2@northwell.edu. 3. Department of Cardiology, Mount Sinai Health System, 5 E 98th St, New York, 10029, USA. 4. Department of Internal Medicine, University of Pittsburgh Medical Center at Shadyside, 5230 Cantre Ave, Pittsburgh, PA, 15232, USA. 5. Department of Radiology, MD Anderson Cancer Center, 8181 Fannin St, Houston, TX, 77504, USA. 6. Department of Cardiovascular Medicine, Staten Island University Hospital, 475 Seaview Ave., New York, 10305, USA.
Abstract
PURPOSE: Paroxysmal supraventricular tachycardia (PSVT) ablation can result in injury to the atrioventricular (AV) node causing complete heart block requiring permanent pacemaker (PPM) implantation. Few studies have examined the impact of hospital PSVT ablation volume and PPM implantation rates post ablation. METHODS: We included adult patients from the Nationwide Inpatient Sample (NIS) database, from 1998 to 2011, using ICD-9 diagnoses codes 427.0 and 427.89 for PSVT and ICD-9 procedure code 37.34 for ablation. Patients with concomitant arrhythmias, prior pacemaker/defibrillator implants, or pre-existing sinus node dysfunction were excluded. Multivariate logistic regression analysis was performed to identify predictors of PPM implantation. RESULTS: There were 119,938 PSVT ablations from 1998 to 2011 with a mean age of 54.6 ± 17.5 years and 64.1% females. The overall PPM implantation rate was 3.2%. PPM implantation rates in the first (1-14 ablations/year), second (15-32 ablations/year), and third (> 32/ablations/year) tertiles of annual PSVT ablation volume were respectively 4.4, 3.3, and 1.9% (p < 0.001). Increasing age, female gender, bifascicular, or trifascicular block and teaching hospital status were independent predictors of PPM implantation. The adjusted odds ratio for PPM implantation in hospitals performing > 32 PSVT ablations/year compared to hospitals performing ≤ 14 PSVT ablations/year was 0.54 (95% confidence interval 0.3-0.9, p = 0.026). CONCLUSIONS: PPM implantation rates are significantly lower in hospitals performing > 32 PSVT ablations/year, indicating that hospital experience is an important determinant of outcomes after PSVT ablation.
PURPOSE:Paroxysmal supraventricular tachycardia (PSVT) ablation can result in injury to the atrioventricular (AV) node causing complete heart block requiring permanent pacemaker (PPM) implantation. Few studies have examined the impact of hospital PSVT ablation volume and PPM implantation rates post ablation. METHODS: We included adult patients from the Nationwide Inpatient Sample (NIS) database, from 1998 to 2011, using ICD-9 diagnoses codes 427.0 and 427.89 for PSVT and ICD-9 procedure code 37.34 for ablation. Patients with concomitant arrhythmias, prior pacemaker/defibrillator implants, or pre-existing sinus node dysfunction were excluded. Multivariate logistic regression analysis was performed to identify predictors of PPM implantation. RESULTS: There were 119,938 PSVT ablations from 1998 to 2011 with a mean age of 54.6 ± 17.5 years and 64.1% females. The overall PPM implantation rate was 3.2%. PPM implantation rates in the first (1-14 ablations/year), second (15-32 ablations/year), and third (> 32/ablations/year) tertiles of annual PSVT ablation volume were respectively 4.4, 3.3, and 1.9% (p < 0.001). Increasing age, female gender, bifascicular, or trifascicular block and teaching hospital status were independent predictors of PPM implantation. The adjusted odds ratio for PPM implantation in hospitals performing > 32 PSVT ablations/year compared to hospitals performing ≤ 14 PSVT ablations/year was 0.54 (95% confidence interval 0.3-0.9, p = 0.026). CONCLUSIONS: PPM implantation rates are significantly lower in hospitals performing > 32 PSVT ablations/year, indicating that hospital experience is an important determinant of outcomes after PSVT ablation.
Authors: Richard L Page; José A Joglar; Mary A Caldwell; Hugh Calkins; Jamie B Conti; Barbara J Deal; N A Mark Estes; Michael E Field; Zachary D Goldberger; Stephen C Hammill; Julia H Indik; Bruce D Lindsay; Brian Olshansky; Andrea M Russo; Win-Kuang Shen; Cynthia M Tracy; Sana M Al-Khatib Journal: J Am Coll Cardiol Date: 2015-09-24 Impact factor: 24.094
Authors: L A Orejarena; H Vidaillet; F DeStefano; D L Nordstrom; R A Vierkant; P N Smith; J J Hayes Journal: J Am Coll Cardiol Date: 1998-01 Impact factor: 24.094