Atrial Fibrillation Catheter Ablation Complications in Obese and Diabetic Patients: Nationwide Inpatient Sample 2005-2013

Abstract

Abstract:Background: Obesity and diabetes are risk factors for atrial fibrillation (AF) incidence and recurrence after catheter ablation. However, their impact on post-ablation complications in real-world practice is unknown.Objectives: We examine annual trends in AF ablations and procedural outcomes in obese and diabetic patients in the US and whether obesity and diabetes are independently associated with adverse outcomes.Methods: Using the Nationwide Inpatient Sample (2005-2013), we identified obese and diabetic patients admitted for AF ablation. Common complications were identified using ICD-9-CM codes. The primary outcome included the composite of any in-hospital complication or death. Annual trends of the primary outcome, length-of-stay (LOS) and total-inflation adjusted hospital charges were examined. Multivariate analyses studied the association of obesity and diabetes with outcomes.Results: An estimated 106,462 AF ablations were performed in the US from 2005-2013. Annual trends revealed a gradual increase in ablations performed in obese and diabetic patients and in complication rates. The overall rate of the primary outcome in obese was 11.7% vs. 8.2% in non-obese and 10.7% in diabetic vs. 8.2% in non-diabetic patients (p<0.001). Obesity was independently associated with increased complications (adjusted OR, 95% CI:1.39, 1.20 - 1.62), longer LOS (1.36, 1.23 - 1.49), and higher charges (1.16, 1.12 - 1.19). Diabetes was only associated with longer LOS (1.27, 1.16 - 1.38). Conclusions: Obesity, but not diabetes, in patients undergoing AF ablation is an independent risk factor for immediate post-ablation complications and higher costs. Future studies should investigate whether weight loss prior to ablation reduces complications and costs.