Edward P Cheng1, Christopher F Liu1, Ilhwan Yeo2, Steven M Markowitz1, George Thomas1, James E Ip1, Luke K Kim1, Bruce B Lerman1, Jim W Cheung3. 1. Weill Cornell Cardiovascular Outcomes Research Group (CORG), Department of Medicine, Division of Cardiology, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York. 2. Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York. 3. Weill Cornell Cardiovascular Outcomes Research Group (CORG), Department of Medicine, Division of Cardiology, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York. Electronic address: jac9029@med.cornell.edu.
Abstract
BACKGROUND: Although procedure-related deaths during index admission following catheter ablation of AF have been reported to be low, adverse outcomes can occur after discharge. There are limited data on mortality early after AF ablation. OBJECTIVES: This study aimed to identify rates, trends, and predictors of early mortality post-atrial fibrillation (AF) ablation. METHODS: Using the all-payer, nationally representative Nationwide Readmissions Database, we evaluated 60,203 admissions of patients 18 years of age or older for AF ablation between 2010 and 2015. Early mortality was defined as death during initial admission or 30-day readmission. Based on International Classification of Diseases-9th Revision, Clinical Modification codes, we identified comorbidities, procedural complications, and causes of readmission following AF ablation. Multivariable logistic regression was performed to assess predictors of early mortality. RESULTS: Early mortality following AF ablation occurred in 0.46% cases, with 54.3% of deaths occurring during readmission. From 2010 to 2015, quarterly rates of early mortality post-ablation increased from 0.25% to 1.35% (p < 0.001). Median time from ablation to death was 11.6 (interquartile range [IQR]: 4.2 to 22.7) days. After adjustment for age and comorbidities, procedural complications (adjusted odds ratio [aOR]: 4.06; p < 0.001), congestive heart failure (CHF) (aOR: 2.20; p = 0.011) and low AF ablation hospital volume (aOR: 2.35; p = 0.003) were associated with early mortality. Complications due to cardiac perforation (aOR: 2.98; p = 0.007), other cardiac (aOR: 12.8; p < 0.001), and neurologic etiologies (aOR: 8.72; p < 0.001) were also associated with early mortality. CONCLUSIONS: In a nationally representative cohort, early mortality following AF ablation affected nearly 1 in 200 patients, with the majority of deaths occurring during 30-day readmission. Procedural complications, congestive heart failure, and low hospital AF ablation volume were predictors of early mortality. Prompt management of post-procedure complications and CHF may be critical for reducing mortality rates following AF ablation.
BACKGROUND: Although procedure-related deaths during index admission following catheter ablation of AF have been reported to be low, adverse outcomes can occur after discharge. There are limited data on mortality early after AF ablation. OBJECTIVES: This study aimed to identify rates, trends, and predictors of early mortality post-atrial fibrillation (AF) ablation. METHODS: Using the all-payer, nationally representative Nationwide Readmissions Database, we evaluated 60,203 admissions of patients 18 years of age or older for AF ablation between 2010 and 2015. Early mortality was defined as death during initial admission or 30-day readmission. Based on International Classification of Diseases-9th Revision, Clinical Modification codes, we identified comorbidities, procedural complications, and causes of readmission following AF ablation. Multivariable logistic regression was performed to assess predictors of early mortality. RESULTS: Early mortality following AF ablation occurred in 0.46% cases, with 54.3% of deaths occurring during readmission. From 2010 to 2015, quarterly rates of early mortality post-ablation increased from 0.25% to 1.35% (p < 0.001). Median time from ablation to death was 11.6 (interquartile range [IQR]: 4.2 to 22.7) days. After adjustment for age and comorbidities, procedural complications (adjusted odds ratio [aOR]: 4.06; p < 0.001), congestive heart failure (CHF) (aOR: 2.20; p = 0.011) and low AF ablation hospital volume (aOR: 2.35; p = 0.003) were associated with early mortality. Complications due to cardiac perforation (aOR: 2.98; p = 0.007), other cardiac (aOR: 12.8; p < 0.001), and neurologic etiologies (aOR: 8.72; p < 0.001) were also associated with early mortality. CONCLUSIONS: In a nationally representative cohort, early mortality following AF ablation affected nearly 1 in 200 patients, with the majority of deaths occurring during 30-day readmission. Procedural complications, congestive heart failure, and low hospital AF ablation volume were predictors of early mortality. Prompt management of post-procedure complications and CHF may be critical for reducing mortality rates following AF ablation.
Authors: Julie K Shade; Rheeda L Ali; Dante Basile; Dan Popescu; Tauseef Akhtar; Joseph E Marine; David D Spragg; Hugh Calkins; Natalia A Trayanova Journal: Circ Arrhythm Electrophysiol Date: 2020-06-14
Authors: Muhammad Bilal Munir; Muhammad Zia Khan; Pratik Agrawal; Zain Ul Abideen Asad; Moinuddin Syed; Kinjan Patel; BilYasir Abdul Ghaffarlal; Muhammad U Khan; Safi U Khan; Sudarshan Balla; Jonathan C Hsu Journal: J Atr Fibrillation Date: 2021-02-28
Authors: Piotr Kulakowski; Agnieszka Sikorska; Roman Piotrowski; Tomasz Kryński; Jakub Baran Journal: J Interv Card Electrophysiol Date: 2021-01-09 Impact factor: 1.900
Authors: Stijn P G van Vugt; Sjoerd W Westra; Rick H J A Volleberg; Gerjon Hannink; Rena Nakamura; Carlo de Asmundis; Gian-Battista Chierchia; Eliano P Navarese; Marc A Brouwer Journal: Europace Date: 2021-12-07 Impact factor: 5.214