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Journal of the American College of Cardiology

Clinical Articles, Featured

Inexperience predicts AF ablation complications

Lack of recent hospital procedure experience is associated with a higher risk of complications and/or 30-day readmission in patients having undergone atrial fibrillation (AF) ablation, according to a study1 published recently in the Journal of the American College of Cardiology.

Researchers led by Dr Rashmee Shah (Stanford University School of Medicine, California) used data from the California State Inpatient Database to identify a large cohort of patients who underwent their first AF ablation in the state from 2005 to 2008. They used multivariable logistic regression to identify predictors of complications and/or 30-day readmissions, and Kaplan-Meier analyses to estimate rates of all-cause and arrhythmia readmissions.

Among a total of 4,156 patients who underwent an initial AF ablation, 5% had periprocedural complications (most commonly vascular) and 9% were readmitted within 30 days. Older age, female, prior AF hospitalisations, and less hospital experience with AF ablation were associated with higher adjusted risk of complications and/or 30-day readmissions. The rate of all-cause hospitalisation was 38.5% by one year. The rate of readmission for recurrent AF, atrial flutter, and/or repeat ablation was 21.7% by one year and 29.6% by two years.

Screen shot 2012-02-07 at 15.19.36

Dr Rashmee Shah

Dr Shah told BJC Arrhythmia Watch: “Atrial fibrillation is a growing health care problem.  Ablation is an exciting new treatment option and is, as we have shown, increasing in use.  Procedural complications and re-hospitalisations for recurrent arrhythmia are concerns as this new treatment modality disseminates.  Studies like ours are important to monitor the progress of ablation and help identify targets for improvement”.

The authors also said: “Our finding of better outcomes among patients treated at centers with more procedural experience in the prior 12 months suggested that higher procedure volumes are needed to gain proficiency, maintain proficiency, or both”.

In an accompanying editorial,2 Dr David Haines (Oakland University William Beaumont School of Medicine, Michigan) comments of the study’s findings that “it would appear that one of the most technically challenging procedures in the field of interventional cardiac electrophysiology is commonly being performed by physicians lacking appropriate experience”.

“It is problematic that complex procedures continue to be performed at very low-volume centers in the U.S. medical system. As long as a hospital is able to profit from supporting interventional procedures by its physicians, there will be a tendency to set a low bar for granting privileges to any doctor who claims proficiency,” he continued.


1 Shah RU, Freeman JV, Shilane D, Wang PJ, Go AS, Hlatky MA.  Procedural complications, rehospitalizations, and repeat procedures after catheter ablation for atrial fibrillation.  JACC 2012;59:143–9.

2 Haines D.  Atrial fibrillation ablation in the real world.  JACC 2012;59:150–2.

Published on: February 7, 2012

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