Impact of Hospital Teaching Status on Atrial Fibrillation Ablation Procedural Approaches and Complications: Insights From the National Cardiovascular Data Registry

Background Institutional characteristics can affect atrial fibrillation (AF) catheter ablation procedural outcomes. Although hospital teaching status may affect patient care in other settings, its effect on AF ablation is unknown. We sought to determine variations in procedural characteristics and complications according to hospital teaching status. Methods We included all adult patients in the prospective National Cardiovascular Data Registry AFib Ablation Registry. Hospitals were categorized as university hospitals, nonuniversity teaching hospitals, and nonteaching hospitals. Associations were analyzed using adjusted logistic regression models. Results A total of 212 327 AF ablations (mean age of patients, 67.0±10.3 years, 35.5% female) were performed between January 2016 and June 2024. University hospitals performed the fewest cryoablations (unadjusted proportions: 14.4% versus 29.9% at nonuniversity teaching hospitals and 16.9% at nonteaching hospitals, P <0.001), adjunctive lesions (59.0% versus 63.3% versus 66.9%, P <0.001), and empiric linear lesions (27.4% versus 30.2% versus 38.1%, P <0.001). Single transseptal punctures were most common at nonuniversity teaching hospitals and least common at nonteaching hospitals (68.9% versus 47.9%, P <0.001). Procedural differences persisted after adjusting for patient characteristics and procedural volume. Same‐day discharge rates were lower at university hospitals compared with nonuniversity teaching hospitals and nonteaching hospitals (34.1% versus 44.5% versus 44.0%, P <0.001). Overall complication rates (2.3% versus 2.2% versus 2.1%, P =0.179) and major complication rates (0.8% versus 0.7% versus 0.7%, P =0.064) were similar based on teaching status. Conclusions After adjustment for patient characteristics and procedural data, AF ablation procedural approaches differ by hospital teaching status. Overall complication rates are low with no differences between hospitals by teaching status.