Early procedure-related mortality affects almost 1 in 200 patients undergoing catheter ablation for atrial fibrillation (AF), according to a new study published in the Journal of the American College of Cardiology. Notably, this rate of postprocedural death exceeds the mortality reported in major randomized, controlled clinical trials.
Catheter ablation is an increasingly used therapeutic strategy for the management of AF and has been shown in numerous major clinical trials such as CASTLE-AF and CABANA to be both effective and safe. No procedure-related deaths were reported in these trials; however, real-world data on early mortality after catheter ablation for AF are scarce. To address this knowledge gap, Cheng and colleagues used data from an all-payer, nationally representative US-based database to assess 30-day mortality and complications linked with catheter ablation for the treatment of AF. Among 60,203 patients who underwent the procedure, 276 (0.46%) patients died early after AF ablation, with 54.3% of these deaths occurring during hospital readmission within 30 days of the procedure. Quarterly postprocedural mortality increased from 0.25% to 1.35% between 2010 and 2015. Advanced age and a higher burden of comorbidities including coronary artery disease, congestive heart failure (CHF) and chronic lung or kidney disease were associated with higher risk of postprocedural death. After adjustment for age and comorbidities, patients who had procedural complications or underwent AF ablation at low-volume centres (defined as hospitals with a case volume of <21 ablations annually) were more likely to die early after AF ablation.
“It should be emphasized that the benefits of [AF] ablation for patients with CHF shown in recent clinical trials have largely involved high-volume academic centres, whose outcomes may not be replicated by lower-volume operators and centres in the real world,” explain the investigators. “Therefore, as more patients with CHF undergo [AF] ablation, the rates of early mortality after the procedure may continue to rise on a national level.”
Cheng, E. P. et al. Risk of mortality following catheter ablation of atrial fibrillation. J. Am. Coll. Cardiol. 74, 2254–2264 (2019)
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Huynh, K. Early mortality after AF ablation. Nat Rev Cardiol 17, 8 (2020). https://doi.org/10.1038/s41569-019-0309-8