In-hospital complications of hybrid vs endocardial atrial fibrillation ablation

Background Hybrid atrial fibrillation (AF) ablation has been used to achieve rhythm control in AF management. It requires both epicardial and endocardial ablation. There is limited evidence regarding the safety of this procedure. Objective To compare in-hospital complication rates between hybrid AF ablation and endocardial catheter ablation (ECA) using a nationally representative dataset. Methods Using the National Inpatient Sample (NIS), we identified patients who underwent AF ablation between 2017 and 2022. The cohort was divided into two groups; those who underwent ECA and those who underwent hybrid AF ablation. The primary outcome was Major Adverse Cardiovascular Events (MACE). Results After propensity score weighting, hybrid ablation was associated with a significantly lower MACE rate (3.1% vs. 5.6%, p=0.0036). Rates of cardiac complications (8.8% vs. 7.5%, p=0.594), infections (2.7% vs. 3.7%, p=0.595), and length of stay (2.96 ± 0.30 vs. 3.19 ± 2.45 days, p=0.285) were comparable between groups. Hybrid ablation was associated with higher rates of hemorrhagic complications (12.7% vs. 4.0%, p < 0.001), with comparable rate of blood transfusion, while pulmonary complications showed a trend toward increase (3.8% vs. 1.5%, p=0.099). Conclusions Hybrid AF ablation was associated with a significantly lower MACE rate compared to ECA, contrasting with earlier studies that suggested higher risk. This shift likely reflects improvements in technique and more refined patient selection. While rates of pulmonary and hemorrhagic complications were higher with hybrid ablation, transfusion needs remained similar between groups.