Catheter ablation of accessory pathway: 14-year trends in utilization and complications in adults in the United States

Abstract

BackgroundThe aim of this study was to determine the temporal trends in utilization of catheter ablation of accessory pathways in the United States. MethodsAll patients from the Nationwide Inpatient Sample (NIS) ≥18years of age with a primary diagnosis of anomalous atrioventricular excitation syndrome (International Classification of Diseases, Ninth Edition, Clinical Modification [ICD-9-CM] code 426.7) were included in the study. Patients who underwent catheter ablation were identified using ICD-9-CM procedure code 37.34. Patients with a concomitant diagnosis of atrial fibrillation, atrial flutter, atrial tachycardia or ventricular arrhythmias were excluded from the analysis. Annual hospital volume was identified using unique hospital identification number and was divided into tertiles for further analysis. ResultsA total of 11,601 catheter ablations for anomalous atrioventricular excitation syndrome were studied from 1998 to 2011. The mean length of stay was 1.8days (median 1day). The utilization trends of accessory pathway ablation have steadily declined from 3.9 ablation procedures/million US population in 1998–1999 to 2.5 ablation procedures/million US population in 2010–2011. The second tertile (adjusted OR 0.41; 95% CI 0.20–0.83, p=0.01) and third tertile (adjusted OR 0.39; 95% CI 0.18–0.85, p=0.02) of hospital volume were associated with reduction in cardiac complications as compared to first tertile of hospital volume. Advanced age (OR 1.02, 95% CI 1.01–1.04, p=0.002) was independent predictor of cardiac complications. There were no in-hospital deaths. ConclusionDespite decline in ablation trends, it still remains a relatively safe procedure associated with low morbidity and no mortality.