Key result
Catheter ablation in non-valvular AF is linked to ~80% lower in-hospital mortality versus no ablation.
Why the study?
Nationwide data on catheter ablation utilization and disparities in non-valvular atrial fibrillation is limited, and literature regarding peri-operative coronary vasospasm complications is limited in Caucasians.
Does catheter ablation improve in-hospital outcomes and is it associated with coronary vasospasm in patients with non-valvular atrial fibrillation?
Observational (n=35,906,946)
Yes
Does catheter ablation improve in-hospital outcomes and is it associated with coronary vasospasm in patients with non-valvular atrial fibrillation?
Effect estimate: OR 0.196 (95% CI 0.179-0.214)
Absolute Event Rate: 0.76% vs 5%
p-value: p=<0.0001
Catheter ablation for non-valvular atrial fibrillation is associated with improved in-hospital clinical outcomes, including lower mortality, without a significant independent association with coronary vasospasm.
Association of ablation with lower NVAF mortality should not yet change practice; leaves open selection bias and requires randomized confirmation.
BACKGROUND: Catheter ablation (CA) is an important curative treatment for non-valvular atrial fibrillation (NVAF), however, nationwide data on its utilization and disparities is limited. Coronary vasospasm is a rare, life-threatening, peri-operative complication of CA with limited literature in Caucasians. METHODS: We performed a retrospective study on adult hospitalizations in the USA from 2007 to 2017 by obtaining the data from National Inpatient Sample. The primary endpoints of our study were to identify the utilization rate of CA, disparities in utilization, and study the outcomes associated with CA. The secondary endpoints of the study were to identify the incidence of coronary vasospasm amongst patients who underwent CA, evaluate their association, and identify the predictors of coronary vasospasm. RESULTS: From 35,906,946 patients with NVAF, 343641 (0.96%) underwent CA. Its utilization decreased from 1% in 2007 to 0.71% in 2017. Patients who underwent CA, compared to those without CA, fared better in terms of hospital length of stay, mortality rate, disability rate, and discharge to the non-home facility. Patients in the 50-75 years age group, Native Americans, those with private insurance, and median household income of 76-100th percentile were associated with higher odds of CA utilization. Urban teaching hospitals and large-bedded hospitals performed more ablations, while the Mid-West region fared lower than the South, the West, and the Northeast. The prevalence of coronary vasospasm was higher amongst CA in comparison without CA, however, in regression analysis, no significant association was demonstrated between CA and coronary vasospasm. CONCLUSION: CA is an important treatment modality that is associated with improved clinical outcomes. Identification of factors associated with lower utilization of CA and its disparities will help to mitigate the burden associated with NVAF.
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Yarrarapu et al. (2023) conducted an observational in Non-valvular Atrial Fibrillation (n=35,906,946). Catheter ablation vs. No catheter ablation was evaluated on In-hospital all-cause mortality (OR 0.196, 95% CI 0.179-0.214, p=<0.0001). Catheter ablation in patients with non-valvular atrial fibrillation was associated with significantly lower in-hospital mortality (adjusted OR 0.196) compared to no ablation.
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