PMID- 26699600
OWN - NLM
STAT- MEDLINE
DCOM- 20160426
LR  - 20151224
IS  - 1097-6744 (Electronic)
IS  - 0002-8703 (Linking)
VI  - 171
IP  - 1
DP  - 2016 Jan
TI  - Trends and predictors of repeat catheter ablation for atrial fibrillation.
PG  - 48-55
LID - S0002-8703(15)00634-1 [pii]
LID - 10.1016/j.ahj.2015.10.015 [doi]
AB  - 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.
CI  - Copyright (c) 2015 Elsevier Inc. All rights reserved.
FAU - Al-Hijji, Mohammed A
AU  - Al-Hijji MA
AD  - Mayo Clinic Heart Rhythm Section, Cardiovascular Diseases, Rochester, MN.
FAU - Deshmukh, Abhishek J
AU  - Deshmukh AJ
AD  - Mayo Clinic Heart Rhythm Section, Cardiovascular Diseases, Rochester, MN.
FAU - Yao, Xiaoxi
AU  - Yao X
AD  - Mayo Clinic Robert D. and Patricia E. Kern Center for Science of Health Care 
      Delivery, Rochester, MN.
FAU - Mwangi, Raphael
AU  - Mwangi R
AD  - Mayo Clinic Robert D. and Patricia E. Kern Center for Science of Health Care 
      Delivery, Rochester, MN.
FAU - Sangaralingham, Lindsey R
AU  - Sangaralingham LR
AD  - Mayo Clinic Robert D. and Patricia E. Kern Center for Science of Health Care 
      Delivery, Rochester, MN.
FAU - Friedman, Paul A
AU  - Friedman PA
AD  - Mayo Clinic Heart Rhythm Section, Cardiovascular Diseases, Rochester, MN.
FAU - Asirvatham, Samuel J
AU  - Asirvatham SJ
AD  - Mayo Clinic Heart Rhythm Section, Cardiovascular Diseases, Rochester, MN.
FAU - Packer, Douglas L
AU  - Packer DL
AD  - Mayo Clinic Heart Rhythm Section, Cardiovascular Diseases, Rochester, MN.
FAU - Shah, Nilay D
AU  - Shah ND
AD  - Mayo Clinic Robert D. and Patricia E. Kern Center for Science of Health Care 
      Delivery, Rochester, MN; Optum Labs, Cambridge, MA.
FAU - Noseworthy, Peter A
AU  - Noseworthy PA
AD  - Mayo Clinic Heart Rhythm Section, Cardiovascular Diseases, Rochester, MN; Mayo 
      Clinic Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, 
      Rochester, MN. Electronic address: Noseworthy.peter@mayo.edu.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20151024
PL  - United States
TA  - Am Heart J
JT  - American heart journal
JID - 0370465
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Atrial Fibrillation/physiopathology/*surgery
MH  - Catheter Ablation/*trends
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Rate/*physiology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Proportional Hazards Models
MH  - *Registries
MH  - Retrospective Studies
MH  - Risk Assessment/*methods
MH  - Risk Factors
MH  - Treatment Outcome
MH  - Young Adult
EDAT- 2015/12/25 06:00
MHDA- 2016/04/27 06:00
CRDT- 2015/12/25 06:00
PHST- 2015/08/03 00:00 [received]
PHST- 2015/10/18 00:00 [accepted]
PHST- 2015/12/25 06:00 [entrez]
PHST- 2015/12/25 06:00 [pubmed]
PHST- 2016/04/27 06:00 [medline]
AID - S0002-8703(15)00634-1 [pii]
AID - 10.1016/j.ahj.2015.10.015 [doi]
PST - ppublish
SO  - Am Heart J. 2016 Jan;171(1):48-55. doi: 10.1016/j.ahj.2015.10.015. Epub 2015 Oct 
      24.