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

Complication Rates

by Steve S. Ryan, PhD, Revised July 29, 2020

Considering a Catheter Ablation for your Atrial Fibrillation? You’d best learn who has the lowest 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 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. But to date, we haven’t had the time and financial resources to produce such a list..

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

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Last updated: Friday, July 31, 2020