Author + information
- Received June 26, 2019
- Revision received October 1, 2019
- Accepted October 3, 2019
- Published online November 27, 2019.
- Asim S. Ahmed, DO∗,
- Brad A. Clark, DO∗,
- Sandeep A. Joshi, MD,
- Girish V. Nair, MD,
- Jeffrey A. Olson, DO,
- Benzy J. Padanilam, MD and
- Parin J. Patel, MD∗ ()
- ↵∗Address for correspondence:
Dr. Parin J. Patel, St. Vincent Medical Group, St. Vincent Hospital, 8333 Naab Road, #400, Indianapolis, Indiana 46260.
Objectives This study sought to determine if atrial fibrillation (AF) ablation can be performed safely without bladder catheterization.
Background Patients undergoing AF ablation often receive bladder catheters. Catheterization is associated with potential complications. The ABCD-AF (Avoiding Bladder Catheters During Atrial Fibrillation) ablation study evaluates the advantages of performing AF ablation without routine catheterization.
Methods In this single-center, prospective, randomized controlled trial, 80 patients received bladder catheterization (group A), and 80 patients received only as-needed catheterization (group B). The primary endpoint was a composite of cystitis, urethral injury, hematuria, dysuria, or urinary retention.
Results Patients’ mean age was 63 ± 13 years, and 33% of patients were female. The primary outcome was reached in 45 patients in group A and 11 patients in group B (p < 0.001). Urinary tract infection occurred in 7 patients in group A and 2 patients in group B (p = 0.17). Urinary retention occurred in 12 patients in group A and 5 patients in group B (p = 0.07). Randomization to catheterization carried an odds ratio of 8.1 ((95 % Confidence Interval [CI]: 3.7 to 17.5; p < 0.001), and male sex carried an odds ratio of 3.8 (95% CI: 1.7 to 8.6; p = 0.001) for the primary endpoint. On subgroup analysis, randomization to undergo catheterization had no association with the primary outcome in female patients but had an odds ratio of 14.6 (95%CI: 5.6 to 38.1; p < 0.001) in male patients. In multivariable analysis, sex and catheter status remained independently associated with the primary outcome.
Conclusions Bladder catheterization can be safely avoided in patients undergoing AF ablation and is associated with a significant reduction in adverse outcomes, especially in men.
- atrial fibrillation
- bladder catheter
- pulmonary vein isolation
- urinary retention
- urinary tract infection
↵∗ Drs. Ahmed and Clark contributed equally to this work and are joint first authors.
This study was funded in part by the St. Vincent Cardiovascular Research Institute. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The 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 June 26, 2019.
- Revision received October 1, 2019.
- Accepted October 3, 2019.
- 2019 American College of Cardiology Foundation
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