Michelle Samuel1, Mohammad Almohammadi2, Meytal Avgil Tsadok1, Jacqueline Joza3, Cynthia A Jackevicius4, Maria Koh5, Hassan Behlouli1, Atul Verma3, Louise Pilote6, Vidal Essebag3. 1. Division of Clinical Epidemiology, McGill University Health Centre Research Institute, Montreal, Quebec, Canada. 2. Division of General Internal Medicine, McGill University Health Centre Research Institute, Montreal, Quebec, Canada. 3. Division of Cardiology, McGill University Health Centre Research Institute, Montreal, Quebec, Canada. 4. Institute of Clinical Evaluative Sciences, University Health Network, University of Toronto, Toronto, Ontario, Canada; Veterans Administration Greater Los Angeles Health System, Western University of Health Sciences, Los Angeles, California. 5. Institute of Clinical Evaluative Sciences, University Health Network, University of Toronto, Toronto, Ontario, Canada. 6. Division of Clinical Epidemiology, McGill University Health Centre Research Institute, Montreal, Quebec, Canada; Division of General Internal Medicine, McGill University Health Centre Research Institute, Montreal, Quebec, Canada. Electronic address: louise.pilote@mcgill.ca.
Abstract
OBJECTIVES: The purpose of this study was to evaluate the safety and incidence of periprocedural adverse events (AEs) among patients who underwent catheter ablation (CA) for atrial fibrillation (AF) in Quebec and Ontario, Canada. BACKGROUND: CA is evolving into the mainstay therapy for patients with symptomatic AF refractory to antiarrhythmic medication. However, the safety of CA at the population level over time requires further evaluation. METHODS: A population-based cohort was constructed using administrative databases of all patients who underwent CA between 1999 and 2014 in Quebec and Ontario, Canada. Incidence and predictors of AEs were assessed within 30 days of CA. Major AEs included all-cause mortality, cerebrovascular accident (CVA) including transient ischemic attack, pericardial effusion requiring drainage (PERD), vascular AEs, hemorrhage/hematoma, and pulmonary embolism. RESULTS: Of 6,388 patients who had a CA (mean age 57.3 years; mean CHA2DS2-VASc 1.1 ± 1.4; 27.6% female), 221 (3.5%) patients developed major AEs within 30 days of index CA. Hemorrhage/hematoma was the most frequent (1.4%), followed by PERD (1.0%) and CVA (0.6%). PERD was more likely to occur post-discharge than during the index CA (p < 0.05). CVA decreased by more than 50% in patients with recent compared with remote CA (p < 0.05). Compared with index CA, the incidence of PERD and hemorrhage/hematoma was greater at first repeat CA (p < 0.05 for both). CONCLUSIONS: CA is a relatively safe procedure with low incidence of major AEs. The incidence of procedure-related CVA appeared to decline significantly over time. Incidence of PERD remained relatively stable and was more likely to be diagnosed after discharge and following repeat CA.
OBJECTIVES: The purpose of this study was to evaluate the safety and incidence of periprocedural adverse events (AEs) among patients who underwent catheter ablation (CA) for atrial fibrillation (AF) in Quebec and Ontario, Canada. BACKGROUND: CA is evolving into the mainstay therapy for patients with symptomatic AF refractory to antiarrhythmic medication. However, the safety of CA at the population level over time requires further evaluation. METHODS: A population-based cohort was constructed using administrative databases of all patients who underwent CA between 1999 and 2014 in Quebec and Ontario, Canada. Incidence and predictors of AEs were assessed within 30 days of CA. Major AEs included all-cause mortality, cerebrovascular accident (CVA) including transient ischemic attack, pericardial effusion requiring drainage (PERD), vascular AEs, hemorrhage/hematoma, and pulmonary embolism. RESULTS: Of 6,388 patients who had a CA (mean age 57.3 years; mean CHA2DS2-VASc 1.1 ± 1.4; 27.6% female), 221 (3.5%) patients developed major AEs within 30 days of index CA. Hemorrhage/hematoma was the most frequent (1.4%), followed by PERD (1.0%) and CVA (0.6%). PERD was more likely to occur post-discharge than during the index CA (p < 0.05). CVA decreased by more than 50% in patients with recent compared with remote CA (p < 0.05). Compared with index CA, the incidence of PERD and hemorrhage/hematoma was greater at first repeat CA (p < 0.05 for both). CONCLUSIONS: CA is a relatively safe procedure with low incidence of major AEs. The incidence of procedure-related CVA appeared to decline significantly over time. Incidence of PERD remained relatively stable and was more likely to be diagnosed after discharge and following repeat CA.