Key result
High comorbidity in AF ablation is linked to ~83% more complications and higher in-hospital mortality.
Why the study?
Despite advancements, only modest incremental success rates have been observed for AF ablation, possibly due to offering treatment to older and sicker patients.
Does a high comorbidity burden increase the risk of in-hospital complications and mortality in patients undergoing catheter ablation for atrial fibrillation?
Does a high comorbidity burden increase the risk of in-hospital complications and mortality in patients undergoing catheter ablation for atrial fibrillation?
The proportion of patients with high comorbidity burden undergoing AF ablation is increasing, and these patients face significantly higher risks of in-hospital complications and mortality.
Rising high-comorbidity AF ablation cases associate with higher risks; extends observational data but leaves optimal selection open.
Background Catheter ablation has become a mainstay treatment for AF in selected patients. However, despite advancements in catheter technique and expertise, only a modest incremental success rate of AF ablations has been observed. It has been suggested that offering the treatment to older and sicker patients may be a contributing factor. We investigated trends in comorbidity burden and its effect as in-hospital outcomes among patients undergoing AF catheter ablation procedures. Methods Using the National Inpatient Sample (NIS) database, patients who underwent AF catheter ablations in the US between 2016 and 2021 were identified using ICD-10 codes. Comorbidity burden was assessed using the Charlson–Deyo comorbidity index (CCI), a weighted index to predict risk of death within 1 year of hospitalization for patients with specific comorbid conditions. Baseline characteristics and in-hospital outcomes were compared between patients with high-CCI scores (≥3) and low-CCI scores (0-2). Annual trends for the rates of high-CCI patients were calculated. Results An estimated total of 42830 patients underwent AF catheter ablation between 2016-2021 in the US. Of these, 6970 (16.3%) had high-CCI score. The annual trend in AF catheter ablations for high-CCI patients gradually increased from 12.1% in 2016 to 20.1% in 2021 (p < 0.001). Compared to low-CCI patients, those with high-CCI scores were older and had higher CHA2DS2-VA and ATRIA bleeding index scores. A Higher rate of total complications was observed in high-CCI patients (14.1% vs 7.7 , p<0.001) primarily driven by vascular, infectious and respiratory complications. In-hospital mortality was also significantly higher among those with high-CCI scores (1.4% vs. 0.2%, p<0.001). Conclusion In recent years, AF catheter ablation has increasingly been utilized in patients with higher comorbidity burden. A careful preprocedural risk-benefit assessment prior to AF ablation would be prudent, as patients with high comorbidity burden are at increased risk for in-hospital complications.
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Margolis et al. (2025) studied this question. High-comorbidity AF ablation patients (CCI≥3) increased from 12.1% to 20.1% (2016-2021) with higher complications (14.1% vs 7.7%) and mortality (1.4% vs 0.2%).
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