Incidence and predictors of 30-day acute cerebrovascular accidents post atrial fibrillation catheter ablation (from the nationwide readmissions database)

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Catheter-based ablation is increasingly being used as first-line therapy for atrial fibrillation (AF). Cerebrovascular accidents (CVA) are a known complication. In this study, we investigate the 30-day incidence and predictors of acute CVA post-catheter ablation for AF. The Nationwide Readmissions Database (NRD) from 2010-September 2015 was queried for hospitalizations with an ablation procedure and a concurrent AF diagnosis. The primary endpoint was a composite endpoint of CVA during index admission or readmission for CVA within 30 days of admission for index hospitalization. The associations between the incidence of endpoints and the covariates of interest; which included age, gender, hospital characteristics (size, procedural volume, urban/rural status, teaching status), CHA2DS2-VASc comorbidity score and its components was assessed using logistic regression. Appropriate survey weighting methodology was applied to generate nationally representative estimates. Of 67,090 weighted hospitalizations for AF ablation, 566 (0.8%) had CVA within 30 days post-ablation. In multivariate regression analysis, factors associated with CVA included hypertension (OR 1.39, 95% CI 1.04, 1.85), heart failure (HF) (OR 4.97, 95% CI 3.32, 7.44), prior stroke/ transient ischemic attack (TIA) (OR 3.25, 95% CI 2.39, 4.42) and a lower procedural volume (OR for higher procedural volume: 0.6, 95% CI 0.42, 0.85). CHA2DS2-VASc score (OR 1.27, 95% CI 1.17, 1.39) was associated with CVA in univariate analysis. In conclusion, the CVA incidence within 30-days of catheter-based AF ablation therapy was 0.8%. Higher CHA2DS2-VASc score was associated with higher risk of CVA post-ablation. Hypertension, HF, prior stroke/TIA, and procedural volume were independently associated with CVA post-ablation.

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