Abstract 18324: Complication Rates of Atrial Fibrillation Ablations: A Comparison of Outcomes From a National Administrative Database to Contemporary Randomized Control Trials
Introduction: The availability, national scope and perceived unbiased nature of administrative data make it the preferred choice for evaluating quality and outcomes. We calculated Atrial Fibrillation ablation complication rates from national administrative data and compared them with data from randomized control trials (RCT).
Methods: Using the Nationwide Inpatient Sample (NIS) we identified patients treated with AF ablations. We investigated complications described with AF ablation and defined them by validated Clinical Modification (ICD-9-CM) diagnosis codes. We compared them with the complication rates reported from AF ablation from widely quoted RCTs. (AF ablation vs. Antiarrhythmics)
Results: We analyzed complication rates from 47042 AF ablations performed from the years 2000 to 2008 from the NIS. We also analyzed pooled complication rates from large RCTs. Cardiac tamponade and/or effusion and vascular access complication appear to be the most frequent complications. The NIS data had a higher rate of cardiac tamponade/effusion (21.5 vs. 12.5), vascular access complications (21.2 vs. 19.7) and deaths (4.0 vs. 3.0) when compared to RCTs. Interestingly, RCTs reported a higher rate of stroke/TIA (13.2 vs. 7) when compared to the national administrative data.
Conclusion: Despite substantial improvement, “real-world” complication rates from administrative data remain higher than those reported in RCTs. The discrepancy may be attributable to differences in operator skills, selection bias and variation in data quality.
- © 2013 by American Heart Association, Inc.