TY - JOUR
T1 - Trends and predictors of repeat catheter ablation for atrial fibrillation
AU - Al-Hijji, Mohammed A.
AU - Deshmukh, Abhishek J.
AU - Yao, Xiaoxi
AU - Mwangi, Raphael
AU - Sangaralingham, Lindsey R.
AU - Friedman, Paul A.
AU - Asirvatham, Samuel J.
AU - Packer, Douglas L.
AU - Shah, Nilay D.
AU - Noseworthy, Peter A.
N1 - Funding Information:
Douglas L. Packer, MD 2013-2014 Consulting services: $0 Abiomed, Biosense Webster, Inc, Boston Scientific, CardioDX, CardioFocus, CardioInsight Technologies, Excerpta Medica, FoxP2 Medica LLC, InfoBionic, Inc, Johnson & Johnson Healthcare Systems, Johnson & Johnson, MediaSphere Medical, LLC, Medtronic CryoCath, OrthoMcNeill, Sanofi-aventis, Siemens, St. Jude Medical, and Siemens AG. Dr Packer received no personal compensation for these consulting activities. Research funding: American Heart Association $10-25k Biosense Webster >$100k Boston Scientific/EPT >$100k Endosense 0 EpiEP $10-25k EP Advocate 0 Medtronic >$100k NIH >$100k CardioFocus <$10k Hansen Medical <$10k St. Jude Medical >$100k Siemens Acuson <$10k Thermedical (EP Limited) $0 Royalties: St. Jude Medical $50-100k Blackwell Publishing <$10k Oxford Royalty <$10k Samuel J. Asirvatham, MD Honoraria/consulting (none significant): Abiomed, Atricure, Biotronik, Biosense Webster, Boston Scientific, Medtronic, Medtelligence, St. Jude, Sanofi-Aventis, Wolters Kluwer, Elsevier, Zoll Co-patent holder—may receive future royalties from: Aegis: appendage ligation Access Point Technologies: AF ablation and coagulum reduction during ablation Nevro: use of nerve signal modulation to treat central, autonomic, and peripheral nervous system disorders, including pain Sanovas: lung ablation Sorin Medical: tricuspid valve project Paul A. Friedman, MD Research Support: St. Jude Intellectual property rights: Aegis Medical NeoChord Preventice Sorin Speaker or consultant: Medtronic Leadex Boston Scientific
PY - 2016/1/1
Y1 - 2016/1/1
N2 - 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 (CHA2DS2-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 <$40,000), patients treated in the south (HR 1.15 [1-1.31]; P <.05), and those on antiarrhythmic medications (HR 1.15 [1.01-1.31]; P <.05). In particular, younger patients (ages 18-54 years) continued to undergo repeat ablations over the entire follow-up period, and the cumulative rate was approximately 40% among those followed for 5 years. Clinical characteristics including those included in the CHA2DS2-Vasc score and Charlson index did not predict likelihood of repeat ablation. The rate of repeat ablation remained constant over the available follow-up. Conclusion Approximately 1 in 8 patients treated with catheter ablation for AF will undergo a second procedure within 1 year, although the rate is as high as 40% in young patients at 5 years. The rate of repeat ablation appears to be associated with demographic characteristics (younger age and higher household income) rather than medical comorbidities.
AB - 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 (CHA2DS2-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 <$40,000), patients treated in the south (HR 1.15 [1-1.31]; P <.05), and those on antiarrhythmic medications (HR 1.15 [1.01-1.31]; P <.05). In particular, younger patients (ages 18-54 years) continued to undergo repeat ablations over the entire follow-up period, and the cumulative rate was approximately 40% among those followed for 5 years. Clinical characteristics including those included in the CHA2DS2-Vasc score and Charlson index did not predict likelihood of repeat ablation. The rate of repeat ablation remained constant over the available follow-up. Conclusion Approximately 1 in 8 patients treated with catheter ablation for AF will undergo a second procedure within 1 year, although the rate is as high as 40% in young patients at 5 years. The rate of repeat ablation appears to be associated with demographic characteristics (younger age and higher household income) rather than medical comorbidities.
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U2 - 10.1016/j.ahj.2015.10.015
DO - 10.1016/j.ahj.2015.10.015
M3 - Article
C2 - 26699600
AN - SCOPUS:84951734218
VL - 171
SP - 48
EP - 55
JO - American Heart Journal
JF - American Heart Journal
SN - 0002-8703
IS - 1
ER -