Clinical Investigation
Trends and predictors of repeat catheter ablation for atrial fibrillation

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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.

Section snippets

Data source

We conducted a retrospective descriptive analysis using administrative claims data from the Optum Labs Data Warehouse, a database including privately insured and a number of Medicare Advantage enrollees throughout the United States.8 The database contains longitudinal health information on >100 million enrollees over the last 20 years from geographically diverse regions across the United States, with greatest representation from the South and Midwest.9 The included plans provide claims for

Results

Between January 2004 and September 2014, 8,648 adult patients in our study cohort underwent catheter ablation for AF. Median age was 61 (interquartile range [IQR] 54-68) years, and 70.9% were men (Table I). A total of 7196 (83.2%) patients in our cohort were white, and 5,995 (69.3%) had been prescribed AADs.

Median follow-up was 1.1 (IQR 0.5-2.3) years. A total of 1,263 (14.6%) patients underwent repeat ablation over a total of 14,280.6 person-years. A total of 9.1 men and 8.2 women underwent

Discussion

The major findings of this study are that (1) about 1 in 8 patients who undergo ablation will undergo a repeat procedure within 1 year of the index ablation, and that (2) the rate of repeat AF ablation may be influenced by demographic characteristics (eg, younger patients, higher household income, southern United States), and (3) is less affected by clinical factors or comorbidities.

The rate of repeat ablation in our study is comparable to the previously reported 11% 1-year repeat ablation rate

Funding sources

None

Disclosures

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

Acknowledgements

None.

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