Early mortality after atrial fibrillation (AF) ablation may be predicted by the occurrence of heart failure, procedural complications, as well as low hospital AF ablation, according to a study published in the Journal of the American College of Cardiology.

In this retrospective study, researchers obtained data gathered between January 2010 and August 2015 by the United States Agency for Healthcare Research and Quality, which administers the Healthcare Cost and Utilization Project and the Nationwide Readmissions Database (NRD). The data of patients aged ≥18 years with primary International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes for AF and a primary ICD-9-CM procedure code for catheter ablation were included in the analysis (n=60,203). Early mortality was defined as death during initial admission or 30-day readmission.

The overall rate of early mortality after AF ablation was 0.46% (95% CI, 0.37%-0.52%). Of the patients who died early after AF ablation (n=276), 45.7% died during the index admission (n=126) and 54.3% died during the 30-day readmission after AF ablation period (n=150). Patients who died early after AF ablation had a higher burden of comorbidities compared with those who survived (40.1% vs 14.4% with Elixhauser comorbidity scores ≥4, respectively; P <.001). The overall rate of any procedural complication during index admission was 6.7%. Patients who died early had higher rates of procedural complications compared with survivors (25.6% vs 6.6%, respectively; P <.001). There was a significant increase in quarterly rates of early mortality from 0.25% to 1.35% between 2010 and 2015 (P <.001 for trend).

Study limitations include its retrospective design, the possibility of miscoding, overcoding, or missing data which may compromise the quality of estimates. In addition, any sudden deaths occurring outside the hospital prior to readmission are not included in this analysis, leading to an underestimation of the early mortality rate after AF ablation. Clinical variables such as left ventricular ejection fraction, left atrial volume, medication, and body mass index were not available. Procedural details were not included in the NRD, limiting the ability to explore the impact of patient cardiac substrate factors or catheter ablation technique on endpoints. “Index procedural complications and congestive heart failure were significant independent predictors of early mortality,” the researchers concluded. “Sepsis and [congestive heart failure] were the leading primary causes of readmission associated with mortality. Implementation of strategies to reduce procedural complications, optimize CHF management, and reduce nosocomial infections may help reduce early mortality after AF ablation.”

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Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Cheng EP, Liu CF, Yeo I, et al. Risk of mortality following catheter ablation of atrial fibrillation. J Am Coll Cardiol. 2019;74:2254-2264.