What is the clinical evidence from this study?

Study design: Observational. Population: Atrial fibrillation, atrial flutter, and ventricular tachycardia (n=43031). Intervention: Catheter ablation. Primary outcome: Major peri-procedural complications.

What question did this study set out to answer?

To assess the real-world incidence of major in-hospital complications and mortality following catheter ablation for atrial fibrillation, atrial flutter, and ventricular tachycardia using patient-level source records.

December 15, 2023EP EuropaceOpen Access

Major in-hospital complications after catheter ablation of cardiac arrhythmias: individual case analysis of 43 031 procedures

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Key result

Catheter ablation carries a ~1.4% major complication rate overall, with highest risks for VT.

n=43,031

Why the study?

In-hospital complications of catheter ablation for AF, AFL, and VT may be overestimated by analyses of administrative data.

What is the incidence of major in-hospital complications after catheter ablation for cardiac arrhythmias when individually adjudicated compared to administrative coding?

Population

43 031 ablations for AF, AFL, and VT in four German tertiary centres

Comparison

AF vs AFL vs VT catheter ablations

Design

Multicentre retrospective observational study with individual case adjudication

Follow-up

In-hospital

Authors

LELars EckardtElectrophysiology FDFlorian DoldiElectrophysiology OAOmar AnwarSemmelweis University

Discussion

Member takes

Implication

Adjudicated rates support lower ablation-related mortality than administrative coding; leaves open need for prospective validation of VT risks.

Key Points

To assess the real-world incidence of major in-hospital complications and mortality following catheter ablation for atrial fibrillation, atrial flutter, and ventricular tachycardia using patient-level source records.
Analyzed N = 43,031 catheter ablation procedures (30,361 AF, 9,364 AFL, and 3,306 VT) performed across four German tertiary centres between 2005 and 2020.
Identified potential complications via G-DRG and OPS administrative coding systems and individually adjudicated all adverse events using patient-level source data.
Major peri-procedural complications occurred in 1.4% (n = 594) of all cases, with rates of 1.1% (n = 325) for AF, 1.0% (n = 95) for AFL, and 5.3% (n = 175) for VT; overall rates increased from 0.76% in 2005 to 1.81% in 2020 (P = 0.004).
True ablation-related in-hospital mortality was lower than coded mortality across all arrhythmias: AF (0.03% vs. 0.04%), AFL (0.04% vs. 0.14%), and VT (0.42% vs. 1.48%).
Adjudicated rates of specific complications included cardiac tamponade in 0.7%, major femoral vascular complications requiring surgery in 0.4%, and stroke in 0.2% of patients.

Study Design

Type

Observational (n=43,031)

Multicenter

Yes

Structured PICO

What is the incidence of major in-hospital complications after catheter ablation for cardiac arrhythmias when individually adjudicated compared to administrative coding?

Population

43,031 catheter ablation procedures for atrial fibrillation (AF, n=30,361), atrial flutter (AFL, n=9,364), and ventricular tachycardia (VT, n=3,306) performed in four German tertiary centres between 2005 and 2020.

Intervention

Catheter ablation for atrial fibrillation, atrial flutter, or ventricular tachycardia

Outcome

Incidences of in-hospital mortality, major bleeding, and stroke (major adverse events including femoral vascular complications, iatrogenic tamponade, stroke, and in-hospital death)safety

Individual case adjudication of administrative data reveals that major complications after catheter ablation are low for AF and AFL (~1.0%) but higher for VT (5.3%), with actual ablation-related mortality being lower than administrative coding suggests.

Cite This Study

Eckardt et al. (2023) conducted an observational in Atrial fibrillation, atrial flutter, and ventricular tachycardia (n=43,031). Catheter ablation was evaluated on Major peri-procedural complications. Major peri-procedural complications after catheter ablation occurred in 1.4% of procedures overall, with rates of 1.1% for AF, 1.0% for AFL, and 5.3% for VT.

synapsesocial.com/papers/6a0eca0206ecbe833447cd94 https://doi.org/10.1093/europace/euad361

Topics

Atrial fibrillation Persistent AF management AF ablation outcomes Ventricular arrhythmias Anticoagulation in AF

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Implication

Adjudicated rates support lower ablation-related mortality than administrative coding; leaves open need for prospective validation of VT risks.

Major in-hospital complications after catheter ablation of cardiac arrhythmias: individual case analysis of 43 031 procedures

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Topics

Major in-hospital complications after catheter ablation of cardiac arrhythmias: individual case analysis of 43 031 procedures

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Also Consider

Topics

Also Consider