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Nov 15, 2019

Study Questions the Safety of a Common Procedure for Treating Atrial Fibrillation

Mortality rates are found to be higher at medical centers that perform fewer catheter ablations than larger hospitals.

While catheter ablation is considered both safe and effective for treating an irregular heart rhythm, the procedure still carries a small risk of death—especially at smaller hospitals with less experience. Findings were recently published in the Journal of the American College of Cardiology and raise concerns about heart procedures performed in non-academic, low-volume hospitals.

Using national hospital data, this study looked at mortality rates associated with catheter ablation for atrial fibrillation (AFib). Atrial fibrillation is an abnormal heart rhythm that increases risk for stroke, heart failure and other serious complications. Catheter ablation is a common procedure used to treat AFib, particularly when medication and lifestyle changes fail to regulate heart rhythm. The procedure is minimally invasive and uses a small catheter to destroy heart tissue that is causing the heart to beat irregularly.

Based on evidence from landmark clinical trials, ablation is safe and effective for treating AFib, with virtually no risk of death. However, outcomes in the real world may be slightly different, based on recent findings.

In the recent study, experts looked at mortality rates among 60,203 AFib patients after undergoing catheter ablation between 2010 and 2015. The study included patients from across the country who were treated at a range of medical centers, rather than the large academic centers that are typically included in clinical trials.

The analysis showed that nearly 1 in 200 participants undergoing catheter ablation died within thirty days of the procedure and that mortality rates increased during the study period from 0.25% in 2010 to 1.25% in 2015. Authors note that most of these deaths occurred after being discharged from the hospital in the month following the procedure.

Procedural complications were associated with four times greater risk of death, while patients with heart failure or who underwent ablation in a low-volume hospital had twofold greater risk of death than those without complications in larger hospitals.

Low-volume hospitals were defined as those performing fewer than 21 ablations per year, which is less than the two ablations a month recommended to maintain skills.

The take-home message, according to authors, is that experience matters when it comes to the safety of catheter ablations. Risk associated with the procedure can vary by hospital, and when possible, patients should choose treatment centers that regularly perform catheter ablations.

Experts also note that close monitoring of high-risk patients—like those with heart failure or those experiencing complications—could help improve outcomes, especially in the month following catheter ablation.

Read the article in the Journal of the American College of Cardiology.

Questions for You to Consider

  • What is atrial fibrillation?

  • Atrial fibrillation is an irregular heart rhythm caused by abnormal, chaotic electrical impulses in the heart’s upper chambers, the atria. These electrical impulses, which interfere with the heart’s natural pacemaker, fire so rapidly the atria cannot beat with a regular rhythm or squeeze out blood effectively. Instead, they merely quiver while the ventricles, the heart’s lower chambers, beat rapidly.
  • How is atrial fibrillation treated?
  • In general, the goals of atrial fibrillation treatment are to promote a regular heart rhythm or rate and prevent blood clots, which can cause stroke. However, treatment strategies depend on the unique needs of each patient. Treatment options may include antiarrhythmic medication, blood thinners, and a variety of procedures that can help control atrial fibrillation.

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