November 14, 2013
View Full PaperImpact of Structural Heart Disease on the Acute Complication Rate in Atrial Fibrillation Ablation: Results from the German Ablation Registry
Key Result
Hypertensive heart disease was an independent predictor of severe, nonfatal complications and death during atrial fibrillation ablation (OR 1.97; 95% CI 1.02-3.83; P=0.0442).
Study Design
Type
Observational (n=6,211)
Multicenter
Yes
Structured PICO
Does underlying structural heart disease increase the risk of complications during catheter ablation of atrial fibrillation?
P
Population
6,211 patients undergoing catheter ablation of atrial fibrillation in 41 nationwide centers in Germany. Divided into No structural heart disease (69.4%), hypertensive heart disease (12.0%), coronary artery disease (15.1%), and cardiomyopathy (3.6%).
I
Intervention
Catheter ablation of atrial fibrillation in patients with structural heart disease (hypertensive heart disease, coronary artery disease, or cardiomyopathy)
C
Comparator
Catheter ablation of atrial fibrillation in patients without structural heart disease
O
Outcome
Acute and long-term complications (severe, nonfatal complications and death)safety
Hypertensive heart disease, but not other structural heart diseases like coronary artery disease or cardiomyopathy, is an independent predictor of severe complications during atrial fibrillation ablation.
Main Result
Effect estimate: OR 1.97 (95% CI 1.02-3.83)
Absolute Event Rate: 7.28% vs 6.01%
p-value: p=0.0442
Abstract
INTRODUCTION: Catheter ablation (CA) has emerged as a widespread therapeutic option in the treatment of atrial fibrillation (AF). Currently, no safety data with regard to the impact of the underlying structural heart diseases (SHD) are available. We sought to assess the risk for acute and long-term complications during CA of AF in relation to underlying SHD. METHODS AND RESULTS: We included 6,211 patients in a prospective registry undergoing CA of AF in 41 nationwide centers. All patients were divided into 4 groups according to the underlying heart disease: No SHD (69.4%), hypertensive heart disease (HHD) (12.0%), coronary artery disease (CAD) (15.1%), and cardiomyopathy (CM) (3.6%). In univariate analysis, patients with HHD had an overall complication rate of 7.28%, whereas patients without an SHD had a significantly lower rate of 6.01% (P < 0.01). Multivariate analysis revealed that HHD (adjusted odds ratio OR: 1.97 95% confidence interval (CI): 1.02-3.83, P = 0.0442) and age (years; OR: 1.04 95% CI: 1.01-1.07, P = 0.0155) were independent predictors of severe, nonfatal complications and death. Other SHD including CAD (OR: 1.48 (0.73-3.00), P = 0.2797) and CM (OR: 2.37 0.70-7.99, P = 0.1630) failed to reach statistical significance. Male sex was protective (OR: 0.47 95% CI: 0.27-0.81, P = 0.0062). CONCLUSION: In general, CA of AF has a low number of severe complications. In our prospective registry HHD emerged as an independent predictor of severe, nonfatal complications during AF ablation but other SHD including CAD and CM did not. The influence of HHD on the complication rate should be considered in patient selection.