What are the trends and in-hospital outcomes of catheter ablation for atrial fibrillation in patients with myeloproliferative neoplasms?

Catheter ablation is the standard of care for symptomatic atrial fibrillation, yet safety and efficacy in patients with myeloproliferative neoplasms (MPNs), a class of hematologic malignancies conferring prothrombotic and inflammatory phenotypes, remains understudied.

We analyzed the National Inpatient Sample (2016-2022), representing 280,450 adult patients undergoing catheter ablation for atrial fibrillation across 147 strata and 17,330 primary sampling units. We identified MPN patients using ICD-10 diagnosis and employed multivariate logistic regression adjusting for 24 covariates including demographics, charlson comorbidity index, and hospital characteristics to assess in-hospital mortality and complications.

1,070 of the catheter ablation patients identified were MPN patients (381.5 per 100,000 ablations). In-hospital mortality rates were comparable between MPN and non-MPN cohorts (0.93% vs. 1.11%, adjusted OR 0.58, 95% CI: 0.14-2.39, p=0.451). While unadjusted analysis revealed elevated acute kidney injury (AKI) in MPN patients (27.1% vs. 21.0%, p=0.027), this association was attenuated after multivariable adjustment (adjusted OR 1.21, 95% CI: 0.84-1.75, p=0.294). MPN status independently predicted longer hospital length of stay (+1.5 days, p=0.026). No significant differences emerged in major bleeding (1.4% vs. 1.7%), cardiac tamponade (0.5% vs. 1.3%), stroke (2.3% vs. 1.4%), or major adverse cardiac events. Temporal trend analysis from 2016-2022 demonstrated stable MPN prevalence (p=0.949) with no significant interaction between MPN status and year for mortality outcomes (p=0.668).

Catheter ablation for atrial fibrillation in MPN patients achieves mortality rates comparable to the general population undergoing ablation, with AKI representing the primary area of heightened vigilance. The results of our study support the procedural safety of catheter ablation in selected MPN patients. These findings identify a base for standardized cardio-oncology protocols addressing arrhythmia management in patients with MPN and other hematologic malignancies.