AF ablation complications linked to low hospital, operator volume

In an analysis of 93,801 catheter ablation procedures in patients with atrial fibrillation (AF), researchers found a complication rate of 6.29 percent, with lower volume of procedures associated with a higher rate of complications. The findings were published in the Nov. 5 issue of Circulation.

The authors, led by Abhishek Deshmukh, MD, of the University of Arkansas for Medical Sciences in Little Rock, used data from the Nationwide Inpatient Sample, a survey of hospitalizations at community hospitals throughout the U.S. They identified patients who underwent catheter ablation of AF between 2000 and 2010.

Overall, the researchers noted an increasing trend of ablation procedures over the 10-year period. Of all the procedures performed, there were 5,909 complications. Cardiac complications were the most common (iatrogenic, pericardial and heart attack, especially). Complications were more frequent in patients older than 80, in women and in patients with certain conditions, such as diabetes, kidney disease, peripheral vascular disease, anemia and depression.

Most of the procedures (81 percent) were done by operators who performed less than 25 per year and in hospitals where less than 50 ablations per year took place. An unadjusted analysis found both these volumes associated with a higher rate of complications. Taking other variables into account revealed an association between a hospital volume of 50 to 100 procedures annually and lower complication rates.

Their findings, the authors argued, warrant a closer look at ways to make ablations safer and improve procedural outcomes.

“Measures should be taken to account for a volume threshold considered optimum to temper the enthusiasm of less experienced operators and enhance the safety of the procedure,” they wrote.

In an editorial, Hugh Calkins, MD, of Johns Hopkins Hospital in Baltimore, called the findings “sobering.”

He argued that AF ablations should only be performed by well-trained operators who have performed a sufficient number of procedures. Additionally, hospitals should take these data into consideration when granting clinical privileges to electrophysiologists. He also called on manufacturers to make equipment more “user friendly” as well as develop newer technologies.

“Finally, the results of this study need to be considered by patients who are making the final decision concerning who will perform their ablation procedure and where it will be performed,” he wrote.