Contemporary trends and in-hospital outcomes of catheter and stand-alone surgical ablation of atrial fibrillation. Issue 2 (4th August 2021)

• Record Type: Journal Article
• Authors: Ariss, Robert W; Khan Minhas, Abdul Mannan; Patel, Neha J; Zafrullah, Fnu; Bhavsar, Krupa; Nazir, Salik; Jneid, Hani; Moukarbel, George V
• Is Part Of: Europace. Volume 24:Issue 2(2022)
• Page Start: 218
• Page End: 225
• Publication Date: 2021-08-04
• Subjects: Stand-alone surgical ablation -- Catheter ablation -- Atrial fibrillation -- Trends -- In-hospital outcome -- Mortality; Arrhythmia -- Treatment -- Periodicals; Cardiac pacing -- Periodicals; Catheter ablation -- Periodicals; Heart -- Physiology -- Periodicals; Electrophysiology -- Periodicals; 617.4120645
• DOI: 10.1093/europace/euab198
• Languages: English
• ISSNs: 1099-5129

Abstract

Abstract: Aims: The contemporary trends in catheter ablation (CA) and surgical ablation (SA) utilization and surgical techniques [open vs. thoracoscopic, with or without left atrial appendage closure (LAAC)] are unclear. In addition, the in-hospital outcomes of stand-alone SA compared with CA are not well-described. Methods and results: The National Inpatient Sample 2010–18 was queried for atrial fibrillation (AF) hospitalizations with CA or stand-alone SA. Complex samples multivariable logistic and linear regression models were used to compare the association between stand-alone SA vs. CA and the primary outcomes of in-hospital mortality and stroke. Of 180 243 hospitalizations included within the study, 167 242 were for CA and 13 000 were for stand-alone SA. Catheter ablation and stand-alone SA hospitalizations decreased throughout the study period ( P trend < 0.001). Surgical ablation had higher rates of in-hospital mortality [adjusted odds ratio (aOR) 2.26; 95% confidence interval (CI) 1.41–3.61; P = 0.001] and stroke (aOR 4.64; 95% CI 3.25–6.64; P < 0.001) compared with CA. When examining different surgical approaches, thoracoscopic SA was associated with similar in-hospital mortality (aOR 1.53; 95% CI 0.60–3.89; P = 0.369) and similar risk of stroke (aOR 1.75; 95% CI 1.00–3.07; P = 0.051) compared with CA. Conclusion: Stand-alone SA comprises a minority of AF ablation procedures and is associated with increased risk of mortality, stroke, and other in-hospital complications compared to CA. However, when a thoracoscopic approach was utilized, the risks of mortality and stroke appear to be reduced.