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Procedural complications, rehospitalizations, and repeat procedures after catheter ablation for atrial fibrillation.

ABSTRACT: The purpose of this study was to estimate rates and identify predictors of inpatient complications and 30-day readmissions, as well as repeat hospitalization rates for arrhythmia recurrence following atrial fibrillation (AF) ablation.AF is the most common clinically significant arrhythmia and is associated with increased morbidity and mortality. Radiofrequency or cryotherapy ablation of AF is a relatively new treatment option, and data on post-procedural outcomes in large general populations are limited.Using data from the California State Inpatient Database, we identified all adult patients who underwent their first AF ablation from 2005 to 2008. We used multivariable logistic regression to identify predictors of complications and/or 30-day readmissions and Kaplan-Meier analyses to estimate rates of all-cause and arrhythmia readmissions.Among 4,156 patients who underwent an initial AF ablation, 5% had periprocedural complications, most commonly vascular, and 9% were readmitted within 30 days. Older age, female, prior AF hospitalizations, and less hospital experience with AF ablation were associated with higher adjusted risk of complications and/or 30-day readmissions. The rate of all-cause hospitalization was 38.5% by 1 year. The rate of readmission for recurrent AF, atrial flutter, and/or repeat ablation was 21.7% by 1 year and 29.6% by 2 years.Periprocedural complications occurred in 1 of 20 patients undergoing AF ablation, and all-cause and arrhythmia-related rehospitalizations were common. Older age, female sex, prior AF hospitalizations, and recent hospital procedure experience were associated with a higher risk of complications and/or 30-day readmission after AF ablation.

SUBMITTER: Shah RU

PROVIDER: S-EPMC5340189 | biostudies-literature | 2012 Jan

REPOSITORIES: biostudies-literature

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Procedural complications, rehospitalizations, and repeat procedures after catheter ablation for atrial fibrillation.

Shah Rashmee U RU Freeman James V JV Shilane David D Wang Paul J PJ Go Alan S AS Hlatky Mark A MA

Journal of the American College of Cardiology 20120101 2

<h4>Objectives</h4>The purpose of this study was to estimate rates and identify predictors of inpatient complications and 30-day readmissions, as well as repeat hospitalization rates for arrhythmia recurrence following atrial fibrillation (AF) ablation.<h4>Background</h4>AF is the most common clinically significant arrhythmia and is associated with increased morbidity and mortality. Radiofrequency or cryotherapy ablation of AF is a relatively new treatment option, and data on post-procedural out ...[more]

PMID: 22222078

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Project description:Background: Little is known about the prognostic value of nutritional status among patients undergoing atrial fibrillation (AF) catheter ablation (AFCA). We compared the risk of procedure-related complications and long-term rhythm outcomes of AFCA according to nutritional status. Methods: We included 3,239 patients undergoing de novo AFCA in 2009-2020. Nutritional status was assessed using the controlling nutritional status (CONUT) score. The association between malnutrition and the risk of AFCA complications or long-term rhythm outcomes was evaluated. We validated the effects of malnutrition using an external cohort of 360 patients undergoing AFCA in 2013-2016. Results: In the study population (26.8% women, median age: 58 years), 1,005 (31.0%) had malnutrition (CONUT scores ≥ 2); 991 (30.6%) had mild (CONUT 2-4) and 14 (0.4%) had moderate-to-severe (CONUT ≥ 5) malnutrition. The overall complication rates after AFCA were 3.3% for normal nutrition, 4.2% for mild malnutrition, and 21.4% for moderate-to-severe malnutrition. Moderate-to-severe malnutrition [odds ratio (OR) 6.456, 95% confidence interval (CI) 1.637-25.463, compared with normal nutrition], older age (OR 1.020 per 1-year increase, 95% CI 1.001-1.039), female sex (OR 1.915, 95% CI 1.302-2.817), and higher systolic blood pressure (OR 1.013 per 1-mmHg increase, 95% CI 1.000-1.026) were independent predictors for the occurrence of complications. In the validation cohort, malnutrition (CONUT ≥ 2) was associated with a 2.87-fold higher risk of AFCA complications (95% CI 1.174-7.033). The association between malnutrition and a higher risk of AFCA complications was consistently observed regardless of body mass index and sex. Malnutrition did not affect rhythm outcomes during the median follow-up of 40 months (clinical recurrence: 37.0% in normal nutrition vs. 36.5% in malnutrition). Conclusion: Malnutrition, which is common in patients undergoing AFCA, was associated with a substantially higher risk for complications after AFCA.

Project description:BackgroundRadiofrequency ablation (RFA) for atrial fibrillation (AF) is associated with a risk of complications. This study aimed to develop and validate risk models for predicting complications after radiofrequency ablation of atrial fibrillation patients.MethodsThis retrospective cohort study included 3365 procedures on 3187 patients with atrial fibrillation at a single medical center from 2018 to 2021. The outcome was the occurrence of postoperative procedural complications during hospitalization. Logistic regression, decision tree, random forest, gradient boosting machine, and extreme gradient boosting were used to develop risk models for any postoperative complications, cardiac effusion/tamponade, and hemorrhage, respectively. Patients' demographic characteristics, medical history, signs, symptoms at presentation, electrocardiographic features, procedural characteristics, laboratory values, and postoperative complications were collected from the medical record. The prediction results were evaluated by performance metrics (i.e., the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, F score, and Brier score) with repeated fivefold cross-validation.ResultsOf the 3365 RFA procedures, there were 62 procedural complications with a rate of 1.84% in the entire cohort. The most common complications were cardiac effusion/tamponade (28 cases, 0.83%), and hemorrhage (21 cases, 0.80%). There was no procedure-related mortality. The machine learning algorithms of random forest (RF) outperformed other models for any complication (AUC 0.721 vs 0.627 to 0.707), and hemorrhage (AUC 0.839 vs 0.649 to 0.794). The extreme gradient boosting (XGBoost) model outperformed other models for cardiac effusion/tamponade (AUC 0.696 vs 0.606 to 0.662).ConclusionsThe developed risk models using machine learning algorithms showed good performance in predicting complications after RFA of AF patients. These models help identify patients at high risk of complications and guiding clinical decision-making.

Project description:AF is a heterogeneous rhythm disorder that is related to a wide spectrum of etiologies and has broad clinical presentations. Mechanisms underlying AF are complex and remain incompletely understood despite extensive research. They associate interactions between triggers, substrate and modulators including ionic and anatomic remodeling, genetic predisposition and neuro-humoral contributors. The pulmonary veins play a key role in the pathogenesis of AF and their isolation is associated to high rates of AF freedom in patients with paroxysmal AF. However, ablation of persistent AF remains less effective, mainly limited by the difficulty to identify the sources sustaining AF. Many theories were advanced to explain the perpetuation of this form of AF, ranging from a single localized focal and reentrant source to diffuse bi-atrial multiple wavelets. Translating these mechanisms to the clinical practice remains challenging and limited by the spatio-temporal resolution of the mapping techniques. AF is driven by focal or reentrant activities that are initially clustered in a relatively limited atrial surface then disseminate everywhere in both atria. Evidence for structural remodeling, mainly represented by atrial fibrosis suggests that reentrant activities using anatomical substrate are the key mechanism sustaining AF. These reentries can be endocardial, epicardial, and intramural which makes them less accessible for mapping and for ablation. Subsequently, early interventions before irreversible remodeling are of major importance. Circumferential pulmonary vein isolation remains the cornerstone of the treatment of AF, regardless of the AF form and of the AF duration. No ablation strategy consistently demonstrated superiority to pulmonary vein isolation in preventing long term recurrences of atrial arrhythmias. Further research that allows accurate identification of the mechanisms underlying AF and efficient ablation should improve the results of PsAF ablation.

Dataset Information

Procedural complications, rehospitalizations, and repeat procedures after catheter ablation for atrial fibrillation.

Publications

Procedural complications, rehospitalizations, and repeat procedures after catheter ablation for atrial fibrillation.

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