Increasing comorbidity burden of patients undergoing catheter ablation for atrial fibrillation in the past 10 years: An analysis of more than 8000 left-atrial ablation procedures
Authors: Obergassel J , Al-Taie C , Remmel M , Taraba S , Rottner L , Riess J L , Nies M , Lemoine M , Ouyang F , Reissmann B , Kirchhof P , Metzner A , Rillig A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Catheter ablation is the most effective rhythm control treatment for atrial fibrillation (AF). While it was indicated as a symptomatic treatment in the past years, prognostic benefits of early rhythm control (ERC) were recently demonstrated and catheter ablation advances more and more into this indication. Restrictions in patient selection for catheter ablation seem to melt. Only few data on comorbidity burden in patients undergoing AF ablation is available.

Purpose
To determine prevalence of common cardiovascular and related comorbidities in patients undergoing left-atrial (LA) procedures between 2010 and 2021 at a large tertiary-care ablation center..

Method
Eligible cases with LA procedures were identified through analysis of coded OPS data between 2010 and 2021. Analysis included patients with atrial fibrillation undergoing an ablation procedure including a transseptal puncture and mapping in the left atrium, not for other supraventricular tachycardias. Analysis accounted for different versions of the ICD-10-GM and OPS-ICHI catalogues. Comorbidities were defined as derived variables on a case-wise analysis from documented ICD-10 and OPS codes. CHA2DS2-VASc-score was calculated from these derived variables and demographic parameters. Procedures were clustered by intervention year in one of following ranges 2010-2012, 2013-2015, 2016-2018 and 2019-2021.

Results
8396 left atrial procedures in 6184 individual patients (35% female, 63.6±11.0 years old at index procedure) were identified. Median CHA2DS2-VASc was 2 (IQR 1;3) in the overall cohort. Mean age increased constantly from 60.3±11.4 years in 2011 to 64.5±11.1 years in 2021. Median CHA2DS2-VASc-score remained constant at 2 points. While the share of non-paroxysmal AF patients was 52% between 2010 and 2012, it increased to 59% in 2016-2018 and decreased again to 55% in 2019-2021. The relative number of cases in which patients suffered from diabetes mellitus, chronic kidney disease, chronic obstructive pulmonary disease (COPD), obstructive sleep apnea (OSA), pulmonary hypertension, coronary artery disease and prior myocardial infarction increased constantly between 2010-2012. While the share of patients with heart failure was highest between 2013 and 2015 (1368/2117 cases, 65%), it decreased to 833/2318 cases (36%) in 2019-2021. the absolute number of procedures nearly doubled from 2010-2012 to 2013-2015, it increased by only 36% from range 2013-2015 to 2016-2018. The number of procedures decreased again from 2016-2018 to 2019-2021 by 19%, likely due to COVID19-pandemic restrictions.

Conclusion
Over the last decade, the age and number of comorbidities increased in patients undergoing AF ablation procedures. These results put emphasis on offering safe procedures and perform adequate pre-procedural assessment of comorbidity burden.