Navigating the challenges of catheter ablation in patients with comorbid alcohol use disorder

Background Alcohol use disorder (AUD) is a significant risk factor for cardiac arrhythmias, contributing to arrhythmogenesis through direct myocardial toxicity and electrical remodeling. The present study evaluated the impact of AUD on clinical and economic outcomes following catheter ablation. Methods The National Inpatient Sample (2010–2019) was used to identify and analyze adults who underwent catheter ablation. Patients were stratified based on the presence of an AUD diagnosis and balanced using a 1:5 propensity score matching for demographics and comorbidities. Outcomes were assessed using logistic regression, Pearson chi-square test, and the Wilcoxon rank-sum test. Results Among the 109,226 patients evaluated, 3,113 (2.85%) had AUD. The AUD cohort was younger, predominantly male, and had higher rates of smoking (40.6% vs. 16.5%), drug abuse (10.3% vs. 5.5%), and liver disease (11.3% vs. 7.8%). After matching, AUD was associated with a longer median length of stay (4.0 vs. 3.0 days, P < 0.001), higher costs ($118,427 vs. $116,503, P < 0.001), and a significantly elevated risk of gastrointestinal complications, particularly esophageal ulcers (0.4% vs. 0.1%, P = 0.006). Interestingly, in-hospital mortality was lower in the AUD group (0.6% vs. 1.4%, P < 0.001). Conclusions The distinct clinical profile and higher risk of specific post-ablation complications among patients with AUD reflect the need for specialized preoperative optimization. Furthermore, the paradoxically lower in-hospital mortality observed in this cohort warrants further investigation and may reflect selection bias favoring a more resilient AUD subgroup.