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Background Ablation therapy is widely used as a treatment of atrial fibrillation (AF) and is associated with 3.6% minor and major complications in the Netherlands. Mortality following AF ablation is rare, but has been reported 0.46% in the United States in recent literature. We hypothesize that in the Netherlands, where AF ablation is performed in high volume centres only, 30-day mortality rate is low. Purpose To describe 30-day mortality in the Netherlands after AF ablation. Methods In the Netherlands Heart Registration, all 16 Dutch ablation centres participate and 14 out of 16 centres reported AF ablation outcomes using predefined variables for quality purposes. The number of reported procedures per centre was on average 236/year [range, 33–593], where 87.5% of the centres perform &amp;gt;150 AF ablations per year. All patients who underwent AF ablation were eligible for this analysis irrespective of ablation method used, or whether it was the first or a redo AF ablation. 30-day mortality was derived from, the municipal death registration, and individually checked by each participating ablation centre. No further analysis was available on the cause of death. Results In total, 20,230 patients who underwent AF ablation between 01-01-2013 and 31-12-2018 were included. The majority of patients were male (68%), mean age was 60.9±9.8 years, mean body mass index was 27.3±4.2kg/m2, and the average CHA2DS2VASc score was 1.6±1.3. Reduced left ventricular (LV) ejection fraction (&amp;lt;50%) was present in 13.2% of the patients. Paroxysmal AF was present in 72.7% of patients, persistent AF in 24.9% and longstanding persistent in 2.3%. The index procedure was a redo-ablation in 22.7%. Mortality outcomes were available for 18,413 (91.0%) procedures, as some centres had a backlog of patients that needed death certificate checking [range, 0% - 19.4%], this factor was considered random. In total 12 patients (0.07%) died within 30-days after an AF ablation procedure. These patients were 68.5 years old [range, 55–76 years], 91.7% had a history of paroxysmal AF and 8.3% persistent AF, LV ejection fraction was &amp;lt;50% in 8.3% and 25% of the patients had a previous AF ablation (p=0.02 for age, others p=NS). Conclusion Patients undergoing AF ablation in the Netherlands mainly presented with paroxysmal AF. In a setting where AF ablation is performed in high volume centres only, such as the Netherlands, 30-day mortality is very low after AF ablation. Funding Acknowledgement Type of funding source: None

Low mortality rate after atrial fibrillation ablation: results from the Netherlands Heart Registration