Trends and predictors of repeat catheter ablation for atrial fibrillation

• Published in: The American heart journal 2016-01, Vol.171 (1), p.48-55
• Main Authors: Al-Hijji, Mohammed A., MD, Deshmukh, Abhishek J., MBBS, Yao, Xiaoxi, PhD, Mwangi, Raphael, Sangaralingham, Lindsey R., MPH, PhD, Friedman, Paul A., MD, Asirvatham, Samuel J., MD, Packer, Douglas L., MD, Shah, Nilay D., PhD, Noseworthy, Peter A., MD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age; Aged; Aged, 80 and over; Atrial Fibrillation - physiopathology; Atrial Fibrillation - surgery; Cardiac arrhythmia; Cardiovascular; Catheter Ablation - trends; Catheters; Codes; Comorbidity; Diabetes; Family income; Female; Follow-Up Studies; Gender; Health insurance; Health Insurance Portability & Accountability Act 1996-US; Heart failure; Heart Rate - physiology; Humans; Hypertension; Male; Middle Aged; Proportional Hazards Models; Registries; Retrospective Studies; Risk Assessment - methods; Risk Factors; Treatment Outcome; Trends; Young Adult
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2015.10.015

Background Atrial fibrillation (AF) ablation is superior to pharmacologic therapy in achieving maintenance of normal sinus rhythm in selected patient populations. However, the procedure is resource intensive, and repeat ablations are sometimes required. We examined the predictors and trends of repeat ablation using a large national administrative claims database. Methods Privately insured and Medicare Advantage patients who underwent catheter ablation for AF between January 1, 2004, and September 30, 2014, were included in the study. The primary outcome was repeat AF ablation during enrollment. We examined the associations between repeat ablation and patient demographics (age, gender, socioeconomic demographics), comorbid conditions (CHA2 DS2 -Vasc score and Charlson index), and year of the index ablation. Cox proportional hazard models were used to identify predictors of repeat ablation. Results We included 8,648 adult patients in the analysis. Median age was 61.0 (interquartile range [IQR] 54-68) years, and 70.9% were men. Median follow-up was 1.1 (IQR 0.5-2.3) years. A total of 1,263 patients underwent repeat ablation (14.6%) over a total of 14,280 person-years (12.1% at 1 year). The hazard ratio (HR) for repeat ablation was higher in younger patients (HR 0.75 [0.61-0.91; P < .01] for age 65-75 and 0.55 [0.4-0.75; P < .001] for age ≥75 compared with age 18-54), those with higher household income (HR 1.24 [1-1.54; P < .05] for household income ≥$100,000 compared with household income