Contemporary utilization and safety outcomes of catheter ablation of atrial flutter in the United States: Analysis of 89,638 procedures

Abstract

Background: Atrial flutter (AFL) ablation has been increasingly offered as first-line therapy and safely performed over the last decades. However, limited data exist regarding current utilization and trends in adverse outcomes arising from this procedure.

Objective: The aim of our study was to examine the frequency of adverse events attributable to AFL ablation and influence of hospital volume on safety outcomes.

Methods: Data were obtained from the Nationwide Inpatient Sample, the largest all-payer inpatient dataset in the United States. Patients with AFL who underwent catheter ablation from 2000 to 2011 were identified using ICD-9 codes. In-hospital death and common complications were identified, including cardiac perforation and tamponade, pneumothorax, stroke, transient ischemic attack, and vascular access complications.

Results: A total of 89,638 AFL patients were treated with catheter ablation during our study period. Total number of ablations performed increased by 154% from 2000 to 2011. The in-hospital mortality rate was 0.17% and the overall complication rate was 3.17%. Cardiac complications (1.44%) were the most frequent, followed by respiratory (0.88%), vascular (0.78%), and neurological complications (0.05%). Low hospital volume (<50 procedures/year) was significantly associated with increased adverse outcomes. Overall frequency of complications per 100 ablation procedures increased from 2.86 in 2000 to 5.39 in 2011 (P < .001).

Conclusions: The overall complication rate was 3.17% in patients undergoing AFL ablation. There was a significant association between low hospital volume and increased adverse outcomes. This suggests a need for future research into identifying the safety measures in AFL ablations and instituting appropriate interventions to improve overall AFL ablation outcomes.

Keywords: Ablation; Atrial flutter; Complications; Safety; Utilization.