Predictors of Readmission Risk After Catheter Ablation for Atrial Fibrillation

Analysis of health records from across the country indicates that improvements in ablation procedures are making them a safer and more effective treatment for patients with atrial fibrillation.

Analysis of health records from across the country indicates that improvements in ablation procedures are making them a safer and more effective treatment for patients with atrial fibrillation (AF)

Researchers from the Mayo Clinic used a large, national administrative claims database to measure hospital readmission rates for 10,705 patients with atrial fibrillation who underwent catheter ablation between January 2009 and December 2013.

A total of 1,433 of those ablation patients (13.4%) were readmitted to a hospital for any cause within 90 days of their initial ablation, and 573 of them (5.3%) were readmitted with AF as the primary diagnosis.

Patients who underwent ablation toward the end of the study period, however, were less likely to return to the hospital than those who underwent ablation several years before. All cause 90-day readmissions fell from 15.6% to 12.8% during the 5-year period (p = 0.04). Readmission attributed to AF fell from 6.4% to 5.0% (p = 0.03).

The study authors noted several limitations in their work, ranging from its retrospective nature to the limited information available in the administrative claims database. Still, they believe their finding to be significant — and cause for some optimism about the treatment of an ever-more-common condition.

“Between 2009 and 2013 there was a reduction in 90-day readmission rates after AF ablation, suggesting improved peri-procedural care of these patients,” they wrote in the American Heart Journal. “Identifying patients at high-risk for readmission after catheter ablation for AF may offer an opportunity for early intervention and, ultimately, reduction in procedural morbidity and medical costs.”

The observed reduction in readmission rates likely stemmed from a combination of improving ablation technology and improving practices at individual medical centers, for a number of recent studies have found practices reduce the risk of stroke and other adverse reactions during and after ablation procedures.

A randomized trial that was written up last year in Circulation, for example, compared the incidence of thromboembolic and hemorrhagic events in 790 patients who discontinued warfarin before ablation and 794 who kept using it normally.

Patients in the first group suffered 39 adverse events (including 29 strokes) in the 48 hours after surgery. Patients in the second group suffered 2 strokes and no transient ischemic attacks (P=<.001).

On the technology front, a study of ablations performed between 2010 and 2012 and published in the Journal of Cardiovascular Electrophysiology found that the use of novel contact force sensing (CFS) technology increased the effectiveness of ablations on patients with paroxysmal AF.

The use of a CFS catheter more than doubled the chances that ablation would keep hearts beating properly throughout the follow-up period that averaged about a year (hazard ratio [HR], 2.24; 95% confidence interval [CI], 1.29—3.90; p = .004).

Of course, not every new ablation device immediately proves itself superior to older technology, of course. Recent trials of ablation systems featuring a either a “cryoballoon” or a “visually guided laser balloon” indicated that they were about as good as — but not significantly better than — standard ablation tools.

Still, the new Mayo study provides further evidence that ablation outcomes are improving over time as physicians adopt technologies and procedures that prove beneficial.