Atrial fibrillation (AF) ablation carried out in an inpatient setting is associated with higher rates of early mortality and subsequent complications when compared with outpatient AF ablation, a new study finds.
Referring to the Medicare fee-for-service (FFS) database, Mary-Jo Obeid (Duke University Medical Center, Durham, USA) and colleagues analysed 122,289 patients undergoing catheter ablation for AF between 2016–2019, determining 30-day mortality in inpatient and outpatient settings.
The study authors note odds of adjusted mortality were analysed with “several methods”, including inverse probability of treatment weighting.
The included cohort had a mean age of 71.9±6.7 years, 44% were women, and the mean CHA2DS2-VASc score was 3.2±1.7. Within this group, 82% underwent AF ablation as an outpatient—the authors recorded an early mortality rate of 0.2% 30 days post-procedure.
Inpatients accounted for 71.5% of deaths (p<0.001)—Obeid et al stating that inpatient ablation was “significantly associated” with complications following a procedure and with early mortality (adjusted odds ratio (aOR) 3.81, 95% confidence interval (CI) 2.87–5.08, p<0.001). Additionally, the study authors state that early mortality was also significantly higher in patients with prevailing comorbidities.
Elucidating their results further, Obeid et al note that hospitals with high overall ablation volumes has 31% lower odds of early mortality (highest versus lowest tertile: aOR 0.69, 95% CI 0.56–0.86, p<0.001).
Interesting study. As a practicing cardiac EP, I am not sure I have ever done an inpatient AF ablation. I am curious what the indication for doing ablation as inpatient. Failed cardioversion? Inability to control rates in atrial fibrillation? It would also be interesting to see if inpatient AF ablation is primarily done by a specific group of electrophysiologists or is most commonly done by electrophysiologists in certain geographic areas.