Introduction: Real world mortality rates after arrhythmia-based procedures, which include electrophysiology (EP) and cardiac implantable electronic device (CIED) procedures, are currently unknown. Knowledge of rates and predictors of adverse events are essential steps for development of quality improvement programs in EP laboratories. Our primary aim was to assess and characterize death after arrhythmia-based procedures over a 16-year period.
Methods: We performed a retrospective cohort study of all patients undergoing arrhythmia-based procedures between January 2000 and November 2016 at the Mayo Clinic. Patients from all three tertiary academic centers (Rochester, Phoenix and Jacksonville) were included in the study. All cases of in-hospital death after arrhythmia-based procedures were identified and were further characterized as directly or indirectly related to the procedure. Subgroup analysis of death was performed for ablation, device implantation, EP study, lead extraction, and defibrillation threshold testing.
Results: A total of 48,913 patients (65.7±6.6 years, 64% male) who underwent a total of 62,065 arrhythmia-based procedures were included in the study. The overall mortality rate in the cohort was 0.36% (95% CI=0.31-0.42). Patients undergoing lead extraction had the highest overall mortality rate at 2% (95% CI=1.43-2.73). Among patients undergoing arrhythmia-based procedures, 52% of deaths directly related to the procedure were among patients undergoing device implantation procedures. Overall, cardiac tamponade was the most common direct cause of death (39%).
Conclusion: Half of the deaths directly related to an arrhythmia-based procedure were among the patients undergoing device implantation procedures, with cardiac tamponade being the most common cause of death. This highlights the importance of development of protocols for quick identification and management of cardiac tamponade even in seemingly lower risk procedures.