PO-02-186 DIFFERENCES IN PATIENT CHARACTERISTICS AND ATRIAL FIBRILLATION ABLATION OUTCOMES BETWEEN HIGH VOLUME ACADEMIC AND COMMUNITY CENTERS- A COMPARISON FROM THE REAL-AF REGISTRY

Abstract

It is unknown whether systematic differences exist in atrial fibrillation (AF) patient characteristics or ablation outcomes between high volume centers from the community or academia. We sought to compare the baseline characteristics, procedural parameters, and outcomes for radiofrequency (RF) ablation of paroxysmal AF performed at community and academic centers in the REAL-AF registry. REAL-AF is a prospective observational registry of high volume AF ablation operators with low fluoroscopy use from both academic and community practices. Using registry data, we compared baseline comorbidities, treatment choices, and arrhythmia free survival between community and academic centers, considering only paroxysmal atrial fibrillation. A total of 853 ablations were performed at community programs and 159 at academic programs. Patients enrolled in the community were more likely to have hypertension (62.8% vs 50.6%), obstructive sleep apnea (46.8% vs 34.6%), vascular disease (18.6% vs 5.1%), and a higher CHADSVASC score (2.5±1.53 vs 2.1±1.32 p<0.05 all - Table 1). Conversely, patients at academic centers had larger mean left atrial size (99.45±36.84 vs 83.75±24.12 cm3 p < 0.05). Patients at academic centers were more likely to receive oral anticoagulation pre-ablation (94.2% vs 85.5% p = 0.03). Procedurally, community centers in REAL-AF were more efficient with lower mean procedure time, RF ablation time and fluoroscopy use (p < 0.05 for all - Table 1). There was similar lesion set choices for the procedure. First pass isolation was achieved similarly between community and academic centers. Ablations in the community had a lower recurrence of -atrial fibrillation (16.2% vs 25.5% p = 0.02 ), however this difference was no longer significant on multivariate analysis accounting for confounders such as left atrial size. In the REAL AF registry, patients undergoing ablation of paroxysmal atrial fibrillation at community centers had more comorbidities but smaller left atrial size when compared to academic centers. High volume community providers were more efficient and used less fluoroscopy. Long-term outcomes were similar after accounting for differences in baseline characteristics.