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. 2018 Dec 1;39(45):4020-4029.
doi: 10.1093/eurheartj/ehy452.

Incidence of complications related to catheter ablation of atrial fibrillation and atrial flutter: a nationwide in-hospital analysis of administrative data for Germany in 2014

Gerhard Steinbeck  1 , Moritz F Sinner  2   3 , Manuel Lutz  4 , Martina Müller-Nurasyid  2   3   4 , Stefan Kääb  2   3 , Holger Reinecke  5
Affiliations

Incidence of complications related to catheter ablation of atrial fibrillation and atrial flutter: a nationwide in-hospital analysis of administrative data for Germany in 2014

Gerhard Steinbeck et al. Eur Heart J. .

Abstract

Aims: Risks of catheter ablation for atrial fibrillation and flutter assessed in retrospective studies, registries, and controlled trials may underestimate 'real world' conditions.

Methods and results: To assess complications in a nationwide approach, we included all cases undergoing catheter ablation for atrial fibrillation and atrial flutter in Germany in 2014, using ICD-10-GM-based German Diagnosis Related Group (G-DRG) codes and the well differentiated German Operation and Procedure Classification (OPS) analysing 33 353 in-hospital cases. For left atrial ablations (19 514 cases), the overall complication rate ranged from a mean of 11.7% to 13.8% depending on type and site of applied energy, including major complications ranging from 3.8% to 7.2%. Whereas overall complication rates were lower for atrial flutter ablations (13 871 cases, 10.5%; P < 0.001), interestingly, major complications occurred more frequently (7.4%; P < 0.001). Particularly, in-hospital death was four-times more common following right than following left atrial ablations (47 vs. 18 cases, 0.34% vs. 0.09%; P < 0.001). Stratified by centre ablation volume, significantly fewer overall complications occurred in centres performing >100 vs. ≤100 left atrial ablations annually (12.7% vs. 16.4%; P < 0.002).

Conclusion: Administrative data of all atrial fibrillation ablations in Germany in 2014 revealed higher overall and major complication rates than previously reported. Few patients were treated in low volume centres, but were exposed to a higher overall complication risk. Atrial flutter ablations were associated with surprisingly high rates of life-threatening complications. Advanced age combined with highly prevalent cardiac, pulmonary and, vascular comorbidities likely play a major role. In addition, individual-level clinical studies need to address the safety and benefits of catheter ablation in an elderly, diseased population.

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Figures

Figure 1
Figure 1
Study overview. A code marked by an asterisk indicates that all subheadings of this code are included. Detailed group definitions are provided in the Methods section and the Supplementary material online.
Figure 2
Figure 2
Complication rates comparing any pulmonary vein isolation and/or left atrial ablation (Groups 1–4) vs. isolated right atrial ablation (Group 5). In each panel, cases with left atrial ablation procedures are displayed by grey bars and right atrial ablations are displayed by black bars. (A–C) Upper row shows complications with significantly higher rates in left vs. right atrial ablations. (D–G) Middle row shows complications with no significant differences between left vs. right atrial ablations. (H–K) Lower row shows complications with significantly higher rates in right vs. left atrial ablations. Groups are defined as in Table 1. Complication rates are expressed as percentage per group and compared by Fisher’s exact tests.
Figure 3
Figure 3
Complication rates by centre ablation volume. Bars represent the cumulative incidences of complications occurring for isolated left atrial ablations and isolated right atrial ablation procedure, respectively, stratified by a centre ablation volume of ≤100 ablation procedures per year (grey bars) or >100 ablation procedures per year (black bars), respectively. The constituents of overall and major complications are provided in Tables 1 and 2. Table cell values individually blinded by the Research Data Center (RDC) for reasons of data protection (‘not assessed’) tend to underestimate the true occurrence of complications. For the aggregate presentation of data in the figure, we, therefore, inferred blinded cell values from all available data in Tables 1 and 2. Only for values not exactly inferable, we assumed a value of ‘1’ as the minimum possible count. Comparisons calculated by Fisher’s exact tests.
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