Author + information
- Received June 4, 2019
- Revision received August 2, 2019
- Accepted August 9, 2019
- Published online October 28, 2019.
- Edward P. Cheng, MD, PhDa,
- Christopher F. Liu, MDa,
- Ilhwan Yeo, MDb,
- Steven M. Markowitz, MDa,
- George Thomas, MDa,
- James E. Ip, MDa,
- Luke K. Kim, MDa,
- Bruce B. Lerman, MDa and
- Jim W. Cheung, MDa,∗ (, )@DrJCheungEP
- aWeill Cornell Cardiovascular Outcomes Research Group (CORG), Department of Medicine, Division of Cardiology, Weill Cornell Medicine–New York Presbyterian Hospital, New York, New York
- bDepartment of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- ↵∗Address for correspondence:
Dr. Jim W. Cheung, Division of Cardiology, Weill Cornell Medical College, 520 East 70th Street, Starr 4, New York, New York 10021.
Background Although procedure-related deaths during index admission following catheter ablation of AF have been reported to be low, adverse outcomes can occur after discharge. There are limited data on mortality early after AF ablation.
Objectives This study aimed to identify rates, trends, and predictors of early mortality post-atrial fibrillation (AF) ablation.
Methods Using the all-payer, nationally representative Nationwide Readmissions Database, we evaluated 60,203 admissions of patients 18 years of age or older for AF ablation between 2010 and 2015. Early mortality was defined as death during initial admission or 30-day readmission. Based on International Classification of Diseases–9th Revision, Clinical Modification codes, we identified comorbidities, procedural complications, and causes of readmission following AF ablation. Multivariable logistic regression was performed to assess predictors of early mortality.
Results Early mortality following AF ablation occurred in 0.46% cases, with 54.3% of deaths occurring during readmission. From 2010 to 2015, quarterly rates of early mortality post-ablation increased from 0.25% to 1.35% (p < 0.001). Median time from ablation to death was 11.6 (interquartile range [IQR]: 4.2 to 22.7) days. After adjustment for age and comorbidities, procedural complications (adjusted odds ratio [aOR]: 4.06; p < 0.001), congestive heart failure (CHF) (aOR: 2.20; p = 0.011) and low AF ablation hospital volume (aOR: 2.35; p = 0.003) were associated with early mortality. Complications due to cardiac perforation (aOR: 2.98; p = 0.007), other cardiac (aOR: 12.8; p < 0.001), and neurologic etiologies (aOR: 8.72; p < 0.001) were also associated with early mortality.
Conclusions In a nationally representative cohort, early mortality following AF ablation affected nearly 1 in 200 patients, with the majority of deaths occurring during 30-day readmission. Procedural complications, congestive heart failure, and low hospital AF ablation volume were predictors of early mortality. Prompt management of post-procedure complications and CHF may be critical for reducing mortality rates following AF ablation.
This work was supported by grants from the Michael Wolk Heart Foundation, the New York Cardiac Center, Inc., and the New York Weill Cornell Medical Center Alumni Council. The Michael Wolk Heart Foundation, the New York Cardiac Center, Inc., and the New York Weill Cornell Medical Center Alumni Council had no role in the design and conduct of the study, the collection, analysis, and interpretation of the data, or the preparation, review, or approval of the manuscript. Dr. Cheung has received consulting fees from Abbott and Biotronik; and has received fellowship grant support from Abbott, Biosense Webster, Biotronik, Boston Scientific, and Medtronic. Dr. Markowitz has received consulting fees from Preventice Medical; and has received fees for serving on the Data Safety Monitoring Board from Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. P. K. Shah, MD, served as Guest Editor-in-Chief for this paper.
- Received June 4, 2019.
- Revision received August 2, 2019.
- Accepted August 9, 2019.
- 2019 American College of Cardiology Foundation
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