Trend Analyses on Interventional Treatment of Atrial Fibrillation From 2016 to 2022: Insights From a Multicenter Hospital Database of Left Atrial Catheter Ablation Cases

BACKGROUND: Current real-world data on the utilization of atrial fibrillation (AF) catheter ablation (CA) are scarce, as is information on the impact of the COVID-19 pandemic on trends in interventional AF treatment. Aims of this study were to describe case characteristics and trends of CA management using a contemporary multicenter database. METHODS: In this retrospective, cross-sectional analysis, we investigated administrative data provided by 87 German hospitals from 01/01/2016 to 12/15/2022. Based on ICD-10 and OPS codes, inpatient cases with a main or secondary discharge diagnosis of AF who underwent CA were extracted. Incidence-rate ratios (IRR) for case numbers with 95% confidence intervals (CI) were calculated using negative binomial models. Trends based on regression analysis were adjusted for baseline variables. RESULTS: Analyzing 29 144 CA cases (89.4% from high-volume centers), a significant increase in case numbers was observed throughout the study period (IRR 1.05, 95% CI 1.03-1.07, p < 0.001). There was no sustained impact on the overall trend from the COVID-19 pandemic, but a temporary drop in case numbers in 2020. Utilization of transesophageal echocardiography (OR 0.82, 95% CI 0.81-0.83, p < 0.001) and intensive care treatment declined (OR 0.92, 95% CI 0.89-0.94, p < 0.001) and there was a trend toward a reduced incidence of pericardial tamponade. The ratio of cryoablations to radiofrequency CA case numbers increased from 0.29 ± 0.06 in 2016 to 0.50 ± 0.07 in 2022. CONCLUSION: We observed an increase in AF CA case numbers over the study period without a sustained influence of the COVID-19 pandemic on this long-term trend. Reported adaptations in CA management deserve further attention.