University of Arkansas for Medical Sciences, Little Rock, AR (A.D., S.D., S.V., G.D., A.S., H.P.); Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., M.K.); Medstar Institute, Washington Hospital Center, Washington, DC (A.C.); University of Miami - Miller School Of Medicine, Miami, FL (P.G., V.S., G.T.S., A.B., R.M., J.F.V.-G.); Drexel University College of Medicine, Philadelphia, PA (K.M.); Wayne State University, Detroit, MI (T.T.); Emory University, Atlanta, GA (K.D.); and University of Kansas, Kansas City, KS (Y.M.R.).
Circulation. 2013 Nov 5;128(19):2104-12. doi: 10.1161/CIRCULATIONAHA.113.003862. Epub 2013 Sep 23.
Atrial fibrillation ablation has made tremendous progress with respect to innovation, efficacy, and safety. However, limited data exist regarding the burden and trends in adverse outcomes arising from this procedure. The aim of our study was to examine the frequency of adverse events attributable to atrial fibrillation (AF) ablation and the influence of operator and hospital volume on outcomes.
With the use of the Nationwide Inpatient Sample, we identified AF patients treated with catheter ablation. We investigated common complications including cardiac perforation and tamponade, pneumothorax, stroke, transient ischemic attack, vascular access complications (hemorrhage/hematoma, vascular complications requiring surgical repair, and accidental arterial puncture), and in-hospital death described with AF ablation, and we defined these complications by using validated International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. An estimated 93,801 AF ablations were performed from 2000 to 2010. The overall frequency of complications was 6.29% with combined cardiac complications (2.54%) being the most frequent. Cardiac complications were followed by vascular complications (1.53%), respiratory complications (1.3%), and neurological complications (1.02%). The in-hospital mortality was 0.46%. Annual operator (<25 procedures) and hospital volume (<50 procedures) were significantly associated with adverse outcomes. There was a small (nonsignificant) rise in overall complication rates.
The overall complication rate was 6.29% in patients undergoing AF ablation. There was a significant association between operator and hospital volume and adverse outcomes. This suggests a need for future research into identifying the safety measures in AF ablations and instituting appropriate interventions to improve overall AF ablation outcomes.
房颤消融术在创新、疗效和安全性方面取得了巨大进展。然而，关于该手术引起的不良结果的负担和趋势，数据有限。我们的研究目的是检查归因于房颤（AF）消融的不良事件的频率，以及术者和医院容量对结果的影响。
我们使用全国住院患者样本，确定了接受导管消融治疗的 AF 患者。我们调查了常见的并发症，包括心脏穿孔和心脏压塞、气胸、中风、短暂性脑缺血发作、血管通路并发症（出血/血肿、需要手术修复的血管并发症和意外动脉穿刺）以及与 AF 消融相关的住院期间死亡，并使用验证的国际疾病分类，第九版，临床修正诊断代码来定义这些并发症。估计 2000 年至 2010 年期间进行了 93801 例 AF 消融术。并发症的总体发生率为 6.29%，其中合并心脏并发症（2.54%）最为常见。心脏并发症后是血管并发症（1.53%）、呼吸并发症（1.3%）和神经并发症（1.02%）。住院死亡率为 0.46%。术者每年（<25 例）和医院每年（<50 例）的手术量与不良结果显著相关。总的并发症发生率略有上升（无统计学意义）。
在接受 AF 消融术的患者中，总体并发症发生率为 6.29%。术者和医院容量与不良结果之间存在显著相关性。这表明需要进一步研究确定 AF 消融术的安全措施，并采取适当的干预措施来改善整体 AF 消融术的结果。
