Breaking News! When It Comes to Complications of Catheter Ablation of Atrial Fibrillation, Experience Matters

During the past decade, catheter ablation of atrial fibrillation (AF) has emerged as an important treatment option for patients with symptomatic AF refractory to anti-arrhythmic drug therapy. The 2012 Heart Rhythm Society/European Heart Rhythm Association/European Cardiac Arrhythmia Society Expert Consensus Document on Catheter Ablation of Atrial Fibrillation provides a Class 1 Level of Evidence A recommendation for catheter ablation of AF in patients with paroxysmal AF who have failed treatment with at least 1 anti-arrhythmic medication and a Class 2 Level of Evidence B recommendation for patients with paroxysmal AF who have not failed anti-arrhythmic drug therapy.1Article see p 2104In the present issue of Circulation , Deshmukh et al2 report the incidence of in-hospital complications of catheter ablation of AF among 93,801 AF ablation procedures performed in the United States between 2000 and 2010. The data were obtained from the Nationwide Inpatient Sample dataset, which is a nationally representative survey of hospitalizations conducted by the Healthcare Cost and Utilization Project. This dataset includes a 20% sample of United States community hospitals. Complications were broken down into 5 groups: (1) cardiac complications; (2) vascular complications; (3) respiratory complications; (4) neurologic complications; and (5) infectious complications. In-hospital mortality was also determined. Delayed complications that commonly present after hospital discharge, including pulmonary vein stenosis and atrial esophageal fistula, could not be evaluated. The data were analyzed to identify predictors of complications and also to determine the relationship between operator and hospital volume with the incidence of complications. There were 5 main findings of this study. First, most of the AF ablation procedures (81%) were performed by operators doing <25 AF ablation procedures per year and in hospitals with annual AF …