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.
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Complications of cavotricuspid isthmus ablation are infrequent and usually limited to vascular access, though in-hospital mortality of 0.17% has been reported.
“Complications of CTI ablation are infrequent, and usually limited to the vascular access, although a 0.17% in-hospital mortality has been reported.161”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [161]
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- Authors
- Patel, N. J., Deshmukh, A., Pau, D., Goyal, V., Patel, S. V., Patel, N., Agnihotri, K., Asirvatham, S., Noseworthy, P., Di Biase, L., Natale, A., & Viles-Gonzalez, J. F.
- Affiliations
- Saint Peter's University Hospital (US)
- Mayo Clinic (US)
- Staten Island University Hospital (US)
- University of Miami (US)
- St David's Medical Center (US)
- ORCID
- Venue
- Heart Rhythm
- Publisher
- Elsevier BV
- Published
- 2016-06
- Volume
- 13
- Issue
- 6
- Pages
- 1317-1325
- ISSN
- 1547-5271 (ISSN-L)
- OpenAlex
- W2252427723
- Cited by
- 46
- References
- 23
- Citations by year
- 2026: 4 · 2025: 1 · 2024: 5 · 2023: 5 · 2022: 1 · 2021: 2 · 2020: 3 · 2019: 6 · 2018: 3 · 2017: 13 · 2016: 3
- FWCI
- 6.88
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Heart Rhythm (publishedVersion)
- PubMed (publishedVersion)
- Cineca Institutional Research Information System (Tor Vergata University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- atrial flutter, catheter ablation, procedural complications, in-hospital mortality, hospital volume, cardiac perforation, tamponade, pneumothorax, stroke, vascular access complications
- MeSH terms
- Aged, Atrial Flutter, Cardiac Tamponade, Female, Humans, Male, Middle Aged, Outcome and Process Assessment, Health Care, Pneumothorax, Postoperative Complications, Risk Factors, United States, Hospital Mortality, Catheter Ablation, Stroke, Hospitals, Low-Volume, Hospitals, High-Volume
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