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Considering a Catheter Ablation? Know Complication Rates When Choosing Your Doctor

Considering a Catheter Ablation for your atrial fibrillation? Know Complication Rates When Choosing Your Doctor

Complication Rates

by Steve S. Ryan, PhD, October 20, 2014

Considering a Catheter Ablation for your Atrial Fibrillation? You’d best learn who has the lowest/highest complication rates before scheduling your Pulmonary Veins Ablation/Isolation (PVI). In his 2014 BAFS presentation, Dr. David Keane,1 of St. Vincent’s University Hospital, Dublin Ireland, presented important research data for patients considering a catheter ablation: The biggest predictor of in-hospital complications was A-Fib ablation operator volume of less than 25 per year.2

Complications highest with low-volume doctors

This makes sense. A doctor performing a small number of Pulmonary Veins Ablation/Isolations (PVIs) a year may not have enough practice to develop and maintain proficiency in a procedure that is extremely operator-skill dependent; and in fact, may never develop the experience necessary for proficiency. The cardiology community agrees. From the Clinical Competency Statement by the ACC/AHA/ACP: “It is recommended that physicians who perform ablations maintain a [minimum] volume of 20 to 50 ablations/year.”3

The biggest predictor of in-hospital complications…was operator volume of less than 25 A-Fib ablation per year.

Shocking: Most Ablation by the Least Proficient

A more surprising research finding was that “more than 81% of…A-Fib ablation procedures in the US were performed by operators with an A-Fib volume of less than 25 per year.” This astounding statistic is a wake-up call for all A-Fib patients. The vast majority of A-Fib ablations are being performed by operators who are probably the least proficient and certainly have the highest complication rates.

Good News: Complications rate is decreasing

On the brighter side, Dr. Keane’s data showed that as A-Fib ablation techniques and experience have improved, the catheter-related complication rate decreased significantly from nearly 7% in 2002 to less than 2% in 2010. During the same period, the number of ablations had more than tripled.4(As a point of reference, the complication rate of the common appendectomy is 18%.)

What this means to A-Fib Patients

As A-Fib patients, we have to make every effort to be treated by high volume centers and operators. In general, high volume doctors are performing so many A-Fib ablations because they’re good at it and highly successful, with lower complication rates. So, you may ask, how can I find out how many ablations my EP does? Right now all you can do is call EP offices and ask how many PVIs they do per year.

On the horizon: Ideally, a more verifiable (and less socially awkward) method would be to have a list of all EPs in your state and how many PVIs they do each year. Such a database would be based on Medicare data.
I intend to build this database and add it to “Steve’s Lists”. (It will take me some time to make this happen as I am a “one man band”, but we will post by state as each is put online. Check ‘Steve’s Lists’ in a few months for our first posts.)

As A-Fib patients, we have to make every effort to be treated by high volume centers and operators.

Disclosure: In October 2014, A-Fib.com received a “no strings attached” charitable grant from Medtronic to create a database from Medicare data, organized by US state, of EPs with their yearly volume of PVIs. We will publish this database on A-Fib.com as a free service to our readers.

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Return to Index of Articles: Catheter Ablation and Maze/Mini-Maze Surgeries

Last updated: Sunday, February 15, 2015

Footnote Citations    (↵ returns to text)

  1. Keane, D. Complications Associated with Catheter Ablation for AF—Overview 2014. Presentation at the 2014 Boston AF Symposium, January 2014. Summary by Steve S. Ryan, PhD on Atrial Fibrillation: Resources for Patients, A-Fib.com
  2. Based on data provided by Medicare regarding Medicare patients having catheter ablations procedures for atrial fibrillation
  3. Tracy, C.M. et al. American College of Cardiology/American Heart Association 2006 Update of the Clinical Competence Statement on Invasive Electrophysiology Studies, Catheter Ablation, and Cardioversion. Journal of the American College of Cardiology. Vol. 48, No. 7, 2006
  4. Hoyt, H et al. Complications arising from catheter ablation of atrial fibrillation: Temporal trends and predictors. Heart Rhythm. 2011;8:1869-1874

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