Catheter ablation of atrial fibrillation resulted in an early mortality rate of 0.46%, with procedural complications acting as a strong predictor of death (aOR 4.06; P<0.001).
Observational (n=60,203)
Yes
What are the rates and predictors of early mortality following catheter ablation of atrial fibrillation in adults?
Early mortality after AF ablation occurs in nearly 1 in 200 patients, with the majority of deaths happening during 30-day readmission, highlighting the need for prompt management of post-procedure complications and heart failure.
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.
“When I first read this paper, my initial reaction was that the findings must be incorrect. I have performed thousands of AF ablation procedures over the past two decades, and I have never had a patient die as a result of the procedure.”
Cheng et al. (2019) conducted an observational in Atrial fibrillation (n=60,203). Catheter ablation of atrial fibrillation was evaluated on Early mortality (death during initial admission or 30-day readmission). Catheter ablation of atrial fibrillation resulted in an early mortality rate of 0.46%, with procedural complications acting as a strong predictor of death (aOR 4.06; P<0.001).