Author + information
- Received April 12, 2017
- Accepted May 4, 2017
- Published online November 20, 2017.
- Seyed Mohammadreza Hosseini, MDa,b,
- Guy Rozen, MD, MHAa,
- Ahmed Saleh, MDa,b,
- Jeena Vaid, MD, MPHa,b,
- Yitschak Biton, MDa,
- Kasra Moazzami, MDa,b,
- E. Kevin Heist, MD, PhDa,b,
- Moussa C. Mansour, MDa,b,
- M. Ihsan Kaadan, MD, MSa,b,
- Mark Vangel, PhDc and
- Jeremy N. Ruskin, MDa,b,∗ ()
- aCardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts
- bDepartment of Medicine, Harvard Medical School, Boston, Massachusetts
- cDepartment of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts
- ↵∗Address for correspondence:
Dr. Jeremy N. Ruskin, Cardiac Arrhythmia Service, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts 02114.
Objectives This study sought to investigate the utilization of and in-hospital complications in patients undergoing catheter ablation in the United States from 2000 to 2013 by using the National Inpatient Sample and Nationwide Inpatient Sample.
Background Catheter ablation has become a mainstay in the treatment of a wide range of cardiac arrhythmias.
Methods This study identified patients 18 years of age and older who underwent inpatient catheter ablation from 2000 to 2013 and had 1 primary diagnosis of any of the following arrhythmias: atrial fibrillation, atrial flutter, supraventricular tachycardia, or ventricular tachycardia.
Results An estimated total of 519,951 (95% confidence interval: 475,702 to 564,200) inpatient ablations were performed in the United States between 2000 and 2013. The median age was 62 years (interquartile range: 51 to 72 years), and 59.3% of the patients were male. The following parameters showed increasing trends during the study period: annual volume of ablations, number of hospitals performing ablations, mean age and comorbidity index of patients, rate of ≥1 complication, and length of stay (p < 0.001 for each). Substantial proportions (27.5%) of inpatient ablation procedures were performed in low-volume hospitals and were associated with an increased risk for complications (odds ratio: 1.26; 95% confidence interval: 1.12 to 1.42; p < 0.001). Older age, greater numbers of comorbidities, and complex ablations for atrial fibrillation and ventricular tachycardia were independent predictors of in-hospital complications and in-hospital mortality. In addition, female sex and lower hospital volumes were independent predictors of complications.
Conclusions From 2000 to 2013, there was a substantial increase in the annual number of in-hospital catheter ablation procedures, as well as the rate of periprocedural complications nationwide. Low-volume centers had a significantly higher rate of complications.
This study was supported in part by the Al Sagri Research Fund and the Deane Institute for Integrative Research in Atrial Fibrillation and Stroke at Massachusetts General Hospital. This work was conducted with support from Harvard Catalyst/The Harvard Clinical and Translational Science Center (National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health Award UL1 TR001102) and financial contributions from Harvard University and its affiliated academic health care centers. The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University and its affiliated academic health care centers, or the National Institutes of Health. Dr. Ruskin is a consultant for Advanced Medical Education, Cardiome, Daiichi-Sankyo, InCarda Therapeutics, and Portola Pharmaceuticals; is on the data monitoring committees of Gilead Sciences and Laguna Medical; is on the scientific advisory boards of InfoBionic and Medtronic; is on the steering committee of Pfizer; and holds equity in Portola Pharmaceuticals and InfoBionic. Dr. Heist is a consultant for Abbott, Biotronik, Biosense Webster, Boston Scientific, Janssen, Medtronic, Pfizer, and St. Jude Medical; and has received research grants from Biotronik and St. Jude Medical. Dr. Mansour is a consultant for Abbott, Biosense Webster, St. Jude Medical, Boston Scientific, and Medtronic; and has received research grants from Abbott, Biosense Webster, Boehringer Ingelheim, Boston Scientific, Medtronic, Pfizer, and St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Drs. Hosseini, Rozen, and Saleh contributed equally to this work.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received April 12, 2017.
- Accepted May 4, 2017.
- 2017 American College of Cardiology Foundation