Complications Associated With Catheter Ablation in Patients With Atrial Fibrillation: A Report From the JROAD-DPC Study

Abstract

Background Aging is one of the major concerns and determinants of the indications for catheter ablation (CA) for atrial fibrillation. This study aimed to assess the safety of CA in older patients with atrial fibrillation undergoing CA. Methods and Results The JROAD-DPC (Japanese Registry of All Cardiac and Vascular Diseases-Diagnosis Procedure Combination) is a nationwide claims database using data from the Japanese Diagnosis Procedure Combination/Per Diem Payment System. Among 6 632 484 records found between April 2012 and March 2018 from 1058 hospitals, 135 299 patients with atrial fibrillation (aged 65±10 years, 38 952 women) who underwent CA in 456 hospitals were studied and divided into the following age groups: <60, 60 to 64, 65 to 69, 70 to 74, 75 to 79, 80 to 84, and ≥85 years. The overall in-hospital complication rate was 3.4% (cardiac tamponade 1.2%), and in-hospital mortality was 0.04%. Older patients had a higher prevalence of women, lower body mass index, and a higher burden of comorbidities such as hypertension, and all of those characteristics were predictors for complications in multivariate analysis. A multivariate adjusted odds ratio revealed that increased age was independently and significantly associated with overall complications (60-64 years, 1.19; 65-69 years, 1.29; 70-74 years, 1.57; 75-79 years, 1.63; 80-84 years, 1.90; and ≥85 years, 2.86; the reference was <60 years). Conclusions The nationwide JROAD-DPC database demonstrated that the frequency of complications following CA in patients with atrial fibrillation increased according to age.

Keywords: Japanese Registry of All Cardiac and Vascular Diseases; atrial fibrillation; catheter ablation; complications; older.

Figure 1. Flowchart of this study.

AF indicates atrial fibrillation; AFL, atrial flutter; AT, atrial tachycardia; CA, catheter ablation; and JROAD‐DPC, Japanese Registry of All Cardiac and Vascular Disease‐Diagnosis Procedure Combination.

Figure 2. Distribution of the CHA₂DS₂‐VASc score in each age group.

The older patients had a significantly higher CHA₂DS₂‐VASc score corresponding to higher age (P<0.001).

Figure 3. Distribution of sex in each age group.

The older patients had a significantly increased rate of women corresponding to higher age (P<0.001).

Figure 4

Multivariate analysis odds ratio for the overall complications according to the age group after an adjustment for the sex, hypertension, diabetes mellitus, heart failure, and hyperlipidemia.