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A substantial increase in hospital catheter ablation procedures in the United States has been accompanied by a nationwide increase in complications related to the procedures, researchers reported.

Rising volumes of catheter ablations for arrhythmias were seen for older patients and those with significant comorbidities during a 14-year period ending in 2013.

Low volume centers had significantly higher complication rates than high-volume hospitals.

"This study demonstrates a significant rise in age and the burden of comorbidities among patients who underwent inpatient ablation procedures, Jeremy Ruskin, MD, of Massachusetts General Hospital, Boston, and colleagues wrote in the August issue of the publication

They added that the changes happened as the complexity of the ablation procedure mix was increasing, with more procedures done for atrial fibrillation (AF) and ventricular tachycardia (VT) ablations.

"More studies are needed to assess the effect of different strategies (e.g., ultrasound-guided femoral access and intracardiac echocardiography) on reducing periprocedural complications and decreasing costly length of stay in patients undergoing in-hospital catheter ablation procedures," the researchers concluded, adding that a major focus should be on improving outcomes at low volume hospitals and among patients at high risk due to comorbidities.

The researchers used the National Inpatient Sample and Nationwide Inpatient Sample (NIS) datasets to identify adult patients who underwent inpatient catheter ablations from 2000 to 2013 due to atrial fibrillation, atrial flutter, supraventricular tachycardia or ventricular tachycardia.

The NIS represents the largest collection of all-payer data on hospitalizations in the U.S., including approximately 20% of all hospital discharges.

Ruskin and colleagues identified an estimated total of 519,951 (95% CI 475,702-564,200) inpatient ablations performed in the U.S. during the period. Median age of patients undergoing catheter ablation was 62 years (IQR 51-72 years), and 59.3% of the patients were male.

Among the main findings:

• Rising numbers of ablations, hospitals performing ablations, patients' mean age and comorbidity burden, patients with at least one complication, and length of stay (P<0.001 for each)
• 27.5% of inpatient ablation procedures performed in low-volume hospitals and associated with increased risk for complications (OR 1.26, 95% CI 1.12-1.42; P<0.001)
• Older age, greater comorbidity volume, and greater ablation complexity for atrial fibrillation and ventricular tachycardia as independent predictors of in-hospital complications and in-hospital mortality
• Female sex and lower hospital volumes as independent predictors of complications

Catheter ablation volumes rose 2.5-fold during the study period, largely driven by procedures for atrial fibrillation (from about 2,000 annually to more than 20,000).

The overall in-hospital complication rate increased during the study period from 3.07% to 7.04%. Significant differences in complication rates were seen among indications: VT ablation had a complication rate of 9.9%, which was approximately three times higher than the rate with procedures for other arrhythmias. The VT group also had the highest comorbidity index (mean 1.28).

Study limitations cited by the researchers included the retrospective nature of the data and the fact that the NIS database included only in-patient catheter ablation procedures. Administrative databases are also subject to coding errors.

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