Open Access

Contemporary trends and in-hospital outcomes of catheter and stand-alone surgical ablation of atrial fibrillation

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Date: 4 August 2021
Journal: EP Europace Journal , Volume 24 , Issue 2 , Pages 218 - 225
Authors: R. Ariss , A. Khan Minhas , N. Patel , F. Zafrullah , K. Bhavsar , S. Nazir , H. Jneid , G. Moukarbel

ESC Journals

AbstractAims

The contemporary trends in catheter ablation (CA) and surgical ablation (SA) utilization and surgical techniques [open vs. thoracoscopic, with or without left atrial appendage closure (LAAC)] are unclear. In addition, the in-hospital outcomes of stand-alone SA compared with CA are not well-described.

Methods and results

The National Inpatient Sample 2010–18 was queried for atrial fibrillation (AF) hospitalizations with CA or stand-alone SA. Complex samples multivariable logistic and linear regression models were used to compare the association between stand-alone SA vs. CA and the primary outcomes of in-hospital mortality and stroke. Of 180 243 hospitalizations included within the study, 167 242 were for CA and 13 000 were for stand-alone SA. Catheter ablation and stand-alone SA hospitalizations decreased throughout the study period (Ptrend<0.001). Surgical ablation had higher rates of in-hospital mortality [adjusted odds ratio (aOR) 2.26; 95% confidence interval (CI) 1.41–3.61; P =0.001] and stroke (aOR 4.64; 95% CI 3.25–6.64; P <0.001) compared with CA. When examining different surgical approaches, thoracoscopic SA was associated with similar in-hospital mortality (aOR 1.53; 95% CI 0.60–3.89; P =0.369) and similar risk of stroke (aOR 1.75; 95% CI 1.00–3.07; P =0.051) compared with CA.

Conclusion

Stand-alone SA comprises a minority of AF ablation procedures and is associated with increased risk of mortality, stroke, and other in-hospital complications compared to CA. However, when a thoracoscopic approach was utilized, the risks of mortality and stroke appear to be reduced.

About the contributors

Robert W Ariss

Role: Author

Abdul Mannan Khan Minhas

Role: Author

Neha J Patel

Role: Author