Heartwire (theheart.org) has reported on a study summarising “real-world” experiences with AF Ablation and found patient factors and hospital procedure volume to be determinants of post-operative complications and rehospitalisation. The article can be found here.
This excerpt reflects the background to the work:
Dr Rashme Shah (Cedars-Sinai Medical Center, Los Angeles, CA) and colleagues analyzed administrative data from 4156 AF ablation cases in the Healthcare Utilization Project California State Inpatient Database in order to provide a more realistic picture of complication rates in contemporary practice, she told heartwire. “Most of the data we have now are from the clinical trials in highly selective populations,” she said. “This investigation really incorporates a broader population that in the real world can be getting this procedure.”
What’s interesting is just how unsurprising the data included in the article becomes on closer scrutiny, to the extent that it could easily have been entitled: Study on Post-op AF complications tells us nothing we didn’t already know.
For example one doctor comments: “Most of the risk factors are [already] well-recognized. For example, women are more fragile for many cardiovascular procedures, and age is important, as is concomitant disease.”
On the finding that “52.1% of patients who had at least one complication) were vascular, usually bleeding” it is commented that “the bleeding rates were not surprising with the procedure, because you use a huge catheter and much blood thinner.”
The AF recurrence rate “wasn’t incredibly high compared with the published data..”
On the comment that; “When we talk about atrial fibrillation, there are many different stages of the disease. So that’s a limitation [of the study]—that you had to put all of these together, and you may have very advanced disease with a very bad result and very young patients with very nice results.” the obvious conclusion is; “If you really want to know what you can offer patients, you have to separate the patients with a small atrium and better conditions from patients with very advanced disease,”
So, at the end of all that we conclude:
More experience/higher caseload = better outcome
Women, older and sicker patients do worse
Most common cause of complication is bleeding
Most common cause of rehospitalisation is Atrial flutter
So how to summarise? Perhaps the words of Dr Lluis Mont (Universitat de Barcelona, Spain) do it best when he points out that; “the study confirms that AF ablation is a relatively safe procedure, since most of the complications are not severe.”
Source: theheart.org, medlatest staff