Ten-year trends in mortality and complications following catheter ablation of atrial fibrillation

Aims
Recent US studies report rising rates of mortality and in-hospital complications following catheter ablation of atrial fibrillation (AF), but whether this is a global phenomenon is uncertain. The aim of this study was to examine trends in 30-day mortality and complications following AF ablation in Australia and New Zealand (ANZ) from 2008 to 2017.
Methods and results
We identified 37 243 AF (mean age 62.4 ± 11.5 years, 29.6% females, 94.5% elective procedures) ablations using national hospitalization data. The primary outcome was occurrence of any complication, including all-cause mortality, within 30 days of discharge. Trends were evaluated using logistic regression adjusting for changes in patient characteristics. The annual number of ablations increased from 1359 (2008) to 5115 (2017). Patients’ age and rates of heart failure (9.8–10.6%), diabetes (6.8–12.4%), and chronic kidney disease (2.2–4.1%) also increased over time. From 2008 to 2017, the overall rate of complications declined from 7.51% to 5.04% [adjusted odds ratio (aOR) 0.96 (95% confidence interval, CI, 0.94–0.97)/year]. Rates of pericardial effusion [1.69–0.70%, aOR 0.93 (0.89–0.97)], bleeding [4.49–2.74%, aOR 0.94 (0.92–0.96)], and vascular injury [0.52–0.16%, aOR 0.91 (0.85–0.98)] declined, but rates of acute kidney injury [0.15–0.68%, aOR 1.16 (1.08–1.25)] and infection [0.15–0.57%, aOR 1.07 (1.01–1.14)] increased over time. The overall 30-day mortality rate was low (0.11%) and unchanged [0.00–0.16%, aOR 0.99 (0.88–1.11)].
Conclusion
Despite a five-fold increase in AF ablations and the rising risk profile of patients, complications following AF ablation declined by 30% from 2008 to 2017 in ANZ. Procedure-related death was uncommon and occurred in less than 1 in 850 patients.