Use and Safety of Urgent vs Elective Catheter Ablation of Atrial Fibrillation in the United States.

BACKGROUND: Despite a common rhythm control strategy, use and safety of atrial fibrillation (AF) ablation pursued urgently among inpatients has not been adequately characterized. OBJECTIVES: This study sought to describe the use and safety of urgent AF ablation, defined as an ablation pursued among inpatients hospitalized for a nonprocedural indication. METHODS: Using the National Cardiovascular Data Registry AFib Ablation Registry, patients who underwent AF ablation from January 1, 2016, to June 30, 2023, were stratified by urgent or elective ablation. Factors, trends, and in-hospital complication rates associated with urgent AF ablation were analyzed. RESULTS: Among 140,051 patients who underwent index AF ablation, 2,714 (1.9%) were conducted as urgent and 137,337 (98.1%) as elective procedures. Those undergoing urgent ablation had higher rates of comorbidities including: diabetes (30.6% vs 20.4%; P < 0.0001), coronary artery disease (30.8% vs 22.7%; P < 0.0001), and heart failure (47.1% vs 20.8%; P < 0.0001). Urgent AF ablation was more often used among Black patients (OR: 1.68; 95% CI: 1.41-2.0) and those presenting to the procedure in AF (OR: 1.73; 95% CI: 1.36-2.20). A higher hospital volume of AF ablations (OR [per 100 cases]: 1.22; 95% CI: 1.20-1.25) was associated with a higher odds of urgent ablation. Urgent AF ablation increased over the study period (0.5% to 2.0%; P < 0.0001) and the adjusted procedure-related complication rate was significantly higher compared with elective ablation (4.9% vs 2.4%; P < 0.0001). CONCLUSIONS: The rate of urgent inpatient AF ablation has increased over time. Compared with elective ablation, patients who underwent urgent AF ablation had more comorbid conditions, particularly heart failure, with a higher rate of risk-adjusted, procedure-related complications.

Duke Scholars

Author Sana Mustapha Al-Khatib Medicine, Cardiology