Relationship between procedural volume and complication rates for catheter ablation of atrial fibrillation: a systematic review and meta-analysis

Author:

Tonchev Ivaylo R1ORCID,Nam Michael Chi Yuan1,Gorelik Alexandra234,Kumar Saurabh56,Haqqani Haris78,Sanders Prashanthan9ORCID,Kistler Peter M10,Kalman Jonathan M1

Affiliation:

1. Department of Cardiology, Royal Melbourne Hospital, Faculty of Medicine, Dentistry, and Health Science, University of Melbourne, Royal Parade. 300 Grattan Street, Parkville, Melbourne, VIC 3050, Australia

2. Department of Medicine, University of Melbourne, Melbourne, VIC 3010, Australia

3. Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, VIC 3144, Australia

4. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia

5. Department of Cardiology, Westmead Hospital, Sydney, NSW 2145, Australia

6. Westmead Applied Research Centre, University of Sydney, Sydney, NSW 2006, Australia

7. Department of Cardiology, The Prince Charles Hospital, Brisbane, QLD 4032, Australia

8. Faculty of Medicine, University of Queensland, Brisbane, QLD 4006, Australia

9. Centre for Heart Rhythm Disorders, University of Adelaide, Royal Adelaide Hospital, Adelaide, SA 5000, Australia

10. Department of Cardiac Electrophysiology, Heart Centre, Alfred Hospital, Melbourne, VIC 3004, Australia

Abstract

Abstract Aims There are conflicting data as to the impact of procedural volume on outcomes with specific reference to the incidence of major complications after catheter ablation for atrial fibrillation. Questions regarding minimum volume requirements and whether these should be per centre or per operator remain unclear. Studies have reported divergent results. We performed a systematic review and meta-analysis of studies reporting the relationship between either operator or hospital atrial fibrillation (AF) ablation volumes and incidence of complications. Methods and results Databases were searched for studies describing the relationship between operator or hospital AF ablation volumes and incidence of complications which were published prior to 12 June 2020. Of 1593 articles identified, 14 (315 120 patients) were included in the meta-analysis. Almost two-thirds of the procedures were performed in low-volume centres. Both hospital volume of ≥50 and ≥100 procedures/year were associated with a significantly lower incidence of complications compared to <50/year (4.2% vs. 5.5%, OR = 0.58, 95% CI 0.50–0.66, P < 0.001) or <100/year (5.5% vs. 6.2%, OR = 0.62, 95% CI 0.53–0.73, P < 0.001), respectively. Hospitals performing ≥50 procedures/year demonstrated significantly lower mortality compared with those performing <50 procedures/year (0.16% vs. 0.55%, OR = 0.33, 95% CI 0.26–0.43, P < 0.001). A similar relationship existed between proceduralist volume of <50/year and incidence of complications [3.75% vs. 12.73%, P < 0.001; OR = 0.27 (0.23–0.32)]. Conclusion There is an inverse relationship between both hospital and proceduralist AF ablation volume and the incidence of complications. Implementation of minimum hospital and operator AF ablation volume standards should be considered in the context of a broader strategy to identify AF ablation Centers of Excellence.

Funder

National Health and Medical Research Council of Australia and by the National Heart Foundation of Australia

Publisher

Oxford University Press (OUP)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

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