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Incidence of complications related to catheter ablation of atrial fibrillation and atrial flutter: a nationwide in-hospital analysis of administrative data for Germany in 2014.
Steinbeck, Gerhard; Sinner, Moritz F; Lutz, Manuel; Müller-Nurasyid, Martina; Kääb, Stefan; Reinecke, Holger.
Afiliação
  • Steinbeck G; University Hospital Munich, Ludwig Maximilians University, Marchioninistr. 15, Munich, Bavaria, Germany.
  • Sinner MF; Department of Medicine I, University Hospital Munich, Ludwig Maximilians University Munich, Marchioninistr. 15, Munich, Bavaria, Germany.
  • Lutz M; German Centre for Cardiovascular Research (DZHK), partner site: Munich Heart Alliance, Biedersteiner Str. 29, Munich, Bavaria, Germany.
  • Müller-Nurasyid M; Institute of Genetic Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Ingolstaedter Landstr. 1, Neuherberg, Bavaria, Germany.
  • Kääb S; Department of Medicine I, University Hospital Munich, Ludwig Maximilians University Munich, Marchioninistr. 15, Munich, Bavaria, Germany.
  • Reinecke H; German Centre for Cardiovascular Research (DZHK), partner site: Munich Heart Alliance, Biedersteiner Str. 29, Munich, Bavaria, Germany.
Eur Heart J ; 39(45): 4020-4029, 2018 12 01.
Article em En | MEDLINE | ID: mdl-30085086
ABSTRACT

Aims:

Risks of catheter ablation for atrial fibrillation and flutter assessed in retrospective studies, registries, and controlled trials may underestimate 'real world' conditions. Methods and

results:

To assess complications in a nationwide approach, we included all cases undergoing catheter ablation for atrial fibrillation and atrial flutter in Germany in 2014, using ICD-10-GM-based German Diagnosis Related Group (G-DRG) codes and the well differentiated German Operation and Procedure Classification (OPS) analysing 33 353 in-hospital cases. For left atrial ablations (19 514 cases), the overall complication rate ranged from a mean of 11.7% to 13.8% depending on type and site of applied energy, including major complications ranging from 3.8% to 7.2%. Whereas overall complication rates were lower for atrial flutter ablations (13 871 cases, 10.5%; P < 0.001), interestingly, major complications occurred more frequently (7.4%; P < 0.001). Particularly, in-hospital death was four-times more common following right than following left atrial ablations (47 vs. 18 cases, 0.34% vs. 0.09%; P < 0.001). Stratified by centre ablation volume, significantly fewer overall complications occurred in centres performing >100 vs. ≤100 left atrial ablations annually (12.7% vs. 16.4%; P < 0.002).

Conclusion:

Administrative data of all atrial fibrillation ablations in Germany in 2014 revealed higher overall and major complication rates than previously reported. Few patients were treated in low volume centres, but were exposed to a higher overall complication risk. Atrial flutter ablations were associated with surprisingly high rates of life-threatening complications. Advanced age combined with highly prevalent cardiac, pulmonary and, vascular comorbidities likely play a major role. In addition, individual-level clinical studies need to address the safety and benefits of catheter ablation in an elderly, diseased population.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Complicações Pós-Operatórias / Fibrilação Atrial / Flutter Atrial / Ablação por Cateter Tipo de estudo: Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Aged80 / Female / Humans / Male / Middle aged País como assunto: Europa Idioma: En Ano de publicação: 2018 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Complicações Pós-Operatórias / Fibrilação Atrial / Flutter Atrial / Ablação por Cateter Tipo de estudo: Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Aged80 / Female / Humans / Male / Middle aged País como assunto: Europa Idioma: En Ano de publicação: 2018 Tipo de documento: Article