Heart Rhythm. 2023 Feb 20:S1547-5271(23)00196-0. doi: 10.1016/j.hrthm.2023.02.016. Online ahead of print.
BACKGROUND: Rates of early mortality and complications following catheter ablation (CA) of atrial fibrillation (AF) vary across healthcare settings.
OBJECTIVE: To identify the rate and predictors of early mortality (within 30 days) following catheter ablation in the inpatient and outpatient settings.
METHODS: Using the Medicare fee for service (FFS) database, we analyzed 122,289 patients that underwent CA for treatment of AF between 2016-2019 to define 30-day mortality in both inpatients and outpatients. Odds of adjusted mortality were assessed with several methods, including inverse probability of treatment weighting.
RESULTS: Mean age was 71.9 ± 6.7 years, 44% were women, and the mean CHA2DS2-VASc score was 3.2 ± 1.7. Overall, 82% underwent AF ablation as an outpatient. The mortality rate 30-days after CA was 0.6%, with inpatients accounting for 71.5% of deaths (p<0.001). Early mortality rates were 0.2% in outpatient procedures and 2.4% in inpatient procedures. The prevalence of co-morbidities were significantly higher in patients with early mortality. Patients with early mortality had significantly higher rates of post-procedural complications. After adjustment, inpatient ablation was significantly associated with early mortality (aOR 3.81, 95% CI 2.87-5.08, p<0.001). Hospitals with high overall ablation volume had 31% lower odds of early mortality (highest vs lowest tertile: aOR 0.69, 95% CI 0.56-0.86, p<0.001).
CONCLUSIONS: AF ablation conducted in the inpatient setting is associated with a higher rate of early mortality compared with outpatient AF ablation. Comorbidities are associated with enhanced risk of early mortality. High overall ablation volume is associated with a lower risk of early mortality.