Procedural Volume and Outcomes with Atrial Fibrillation Ablation: A Report from the NCDR AFib Ablation Registry

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dc.contributor.authorKattel, S.
dc.contributor.authorTan, Z.
dc.contributor.authorLin, Z.
dc.contributor.authorMszar, R.
dc.contributor.authorSanders, P.
dc.contributor.authorZeitler, E.P.
dc.contributor.authorZei, P.C.
dc.contributor.authorBunch, T.J.
dc.contributor.authorMansour, M.
dc.contributor.authorAkar, J.
dc.contributor.authorCurtis, J.P.
dc.contributor.authorFriedman, D.J.
dc.contributor.authorFreeman, J.V.
dc.date.issued2025
dc.descriptionAvailable online 2 July 2024
dc.description.abstractBACKGROUND: The association between hospital and physician procedure volume outcome has not been well evaluated for atrial fibrillation (AF) ablation in contemporary practice. OBJECTIVE: To determine the association between hospital and physician AF ablation volume and procedural success (isolation of all pulmonary veins) and major adverse events (MAE). METHODS: Procedures reported to the NCDR AFib Ablation Registry between July 2019 and June 2022 were included. Hospital and physician procedural volumes were annualized and stratified into quartiles (Q) to compare outcomes. Three level hierarchical (patient, hospital and physician) models were used to assess the procedural volume outcome relationship. RESULTS: A total of 70,296 first-time AF ablations at 186 U.S. hospitals were included. Overall, procedural success and MAE rate were 98.5 % and 1.0% respectively. With hospital volume (Q4) as a reference, the likelihood of procedural success was lower for Q1 (OR 0.44, 95%CI 0.29-0.68), Q2 (OR 0.50, 95%CI 0.33-0.75) and Q3 (OR 0.60, 95%CI 0.40-0.89); the results were similarly signifant for physician volume. With MAE for hospitals, there was an inverse procedural volume relationship for Q1 (OR 1.78, 95%CI 1.26-2.51) but not for Q2 (OR 1.06, 95%CI 0.77-1.46) or Q3 (OR 1.19, 95%CI 0.89-1.58) and similarly for physicians in Q1 and Q2, not in Q3. An adjusted MAE ≤ 1% was predicted by an annual volume of approximately 190 for hospitals and 60 for physicians. CONCLUSION: In this national cohort, hospital and physician AF ablation procedural volumes were directly related to acute procedural success and inversely related to rates of MAE.
dc.description.statementofresponsibilitySharma Kattel, Zhen Tan, Zhenqiu Lin, Reed Mszar, Prashanthan Sanders, Emily P. Zeitler, Paul C. Zei, T Jared Bunch, Moussa Mansour, Joseph Akar, Jeptha P. Curtis, Daniel J. Friedman, James V. Freeman
dc.identifier.citationHeart Rhythm, 2025; 22(1):37-48
dc.identifier.doi10.1016/j.hrthm.2024.06.056
dc.identifier.issn1547-5271
dc.identifier.issn1556-3871
dc.identifier.orcidSanders, P. [0000-0003-3803-8429]
dc.identifier.urihttps://hdl.handle.net/2440/141740
dc.language.isoen
dc.publisherElsevier
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/2017798
dc.rights© 2024 Published by Elsevier Inc. on behalf of Heart Rhythm Society.
dc.source.urihttp://dx.doi.org/10.1016/j.hrthm.2024.06.056
dc.subjectatrial fibrillation ablation
dc.subjectprocedural major adverse events
dc.subjectprocedural success
dc.subjectprocedural volume
dc.titleProcedural Volume and Outcomes with Atrial Fibrillation Ablation: A Report from the NCDR AFib Ablation Registry
dc.typeJournal article
pubs.publication-statusPublished

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