Atrial Fibrillation Study Shows Importance of Clinical Expertise, Volume
In the largest study ever done in patients undergoing catheter ablation of atrial fibrillation in the United States, a multi-center team, led by Miller School physicians and scientists, has made a critical discovery in predicting adverse outcomes. The investigators found that although the procedure is safe and the absolute number of complications is small, there are some complications that continue to increase as the procedure is performed in more centers in the nation.
The study, published in the online edition of Circulation, the journal of the American Heart Association, reported on outcomes and complications associated with the procedure in more than 90,000 patients over a decade from 2000-2010.
Juan Viles-Gonzalez, M.D., assistant professor of medicine in the Cardiovascular Division, led the study which examined the influence of physician and hospital volume on outcomes of this procedure. The growth in the number of atrial fibrillation procedures was driven by a significant increase in the number of small-volume hospitals and physicians.
The overall frequency of complications was 6.29 percent, with combined cardiac complications (2.54 percent) being the most frequent. One important finding was that the outcomes, particularly in-hospital complications, were clearly related to the experience of the physicians. The group that had more complications were those who performed fewer than 25 atrial fibrillation ablation procedures per year.
“The work of Juan and his team provides invaluable information on how to improve outcomes for patients with atrial fibrillation,” said Pascal J. Goldschmidt, M.D., Senior Vice President for Medical Affairs and Dean of the Miller School, and a renowned cardiologist. “This study demonstrates that, as is often the case for other invasive cardiac procedures, expertise and volume are determining factors for success of catheter ablation of atrial fibrillation.”
Viles-Gonzalez and first author Abhishek Deshmukh, M.D., a cardiology fellow at the University of Arkansas for Medical Sciences, found that there were a significantly higher number of complications in patients over age 80 who underwent atrial fibrillation ablations. The researchers also found that complication rates following atrial fibrillation ablation in women were higher compared to men, suggesting that more study is needed in this area.
Mauro Moscucci, M.D., M.B.A., professor of medicine and Interim Chair of the Department of Medicine, said the findings taken together “highlight the continuous value of the old adage that ‘practice makes perfect,’ as it has been shown for other surgical and minimally invasive procedures. In addition, they raise the question of whether regionalizing healthcare resources in high-volume centers could result in improved outcomes for patients with atrial fibrillation.”
Viles-Gonzalez said, “The findings of our study could modify the professional guidelines when it comes to defining ‘competency’ in the area of treatment of atrial fibrillation. Volume threshold may be a determining factor to enhance safety of the procedure.”
Other Miller School researchers involved in the study, “In-hospital Complications Associated with Catheter Ablation of Atrial Fibrillation in the United States between 2000-2010: Analysis of 93,801 Procedures,” include cardiovascular residents Peeyush Grover, M.D., Vikas Singh, M.D., Apurva Badheka, M.D., and Ghanshyambhai T. Savani, M.D., and Raul Mitrani, M.D., associate professor of medicine.