Cardiology Xagena

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Risk of mortality following catheter ablation of atrial fibrillation

Although procedure-related deaths during index admission following catheter ablation of atrial fibrillation ( AF ) have been reported to be low, adverse outcomes can occur after discharge.
There are limited data on mortality early after AF ablation.

The study has aimed to identify rates, trends, and predictors of early mortality post-atrial fibrillation ablation.

Investigators have evaluated 60,203 admissions of patients 18 years of age or older for atrial fibrillation ablation between 2010 and 2015.
Early mortality was defined as death during initial admission or 30-day readmission.

Early mortality following atrial fibrillation 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 less than 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 less than 0.001 ), congestive heart failure ( CHF ) ( aOR: 2.20; p = 0.011 ) and low atrial fibrillation 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 less than 0.001 ), and neurologic etiologies ( aOR: 8.72; p less than 0.001 ) were also associated with early mortality.

In conclusion, in a nationally representative cohort, early mortality following atrial fibrillation 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 heart failure may be critical for reducing mortality rates following AF ablation. ( Xagena )

Cheng E et al, Journal of the American College of Cardiology Volume 73, Issue 9 Supplement 1, 2019