Considering a Catheter Ablation? Know Complication Rates When Choosing Your Doctor
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.
Last updated: Sunday, February 15, 2015
- 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↵
- Based on data provided by Medicare regarding Medicare patients having catheter ablations procedures for atrial fibrillation↵
- 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↵
- Hoyt, H et al. Complications arising from catheter ablation of atrial fibrillation: Temporal trends and predictors. Heart Rhythm. 2011;8:1869-1874↵