Introduction: Atrial flutter (AFL) ablation is associated with significant complications. Recognition of predictors of worse outcomes early is critical.
Methods: National Readmission Data (NRD) 2013-14 was utilized to select study cohort and AFL and Cather ablation were identified using International Classification of Diseases, 9th Revision (ICD-9-CM) diagnostic code 427.32 and procedure code 37.34 respectively. Admissions within 90 day of index admission were considered as early readmissions. Cox proportional hazard regression and hierarchical two level logistic models were used to evaluate predictors of early readmission and complications.
Result: A total of 1010 patients were readmitted (18.36%). Significant predictors of early readmission included [Hazards Ratio (HR), 95% confidence interval (CI), p-value] heart failure (HR: 1.30, 95% CI: 1.13 - 1.49, p < 0.001), chronic pulmonary disease (HR: 1.37, 95% CI: 1.18 - 1.58, p < 0.001), anemia (HR: 1.23, 95% CI: 1.02 - 1.49, p = 0.035), malignancy (HR: 1.87, 95% CI: 1.40 - 2.49, p<0.001), weekend admission(HR: 1.23, 95% CI: 1.02 - 1.47, p = 0.029) compared to weekday admission, index hospitalization length of stay of 3 to 4 days(HR: 1.29, 95% CI: 1.09 - 1.52, p = 0.003) and ≥ 5days (HR: 1.39, 95% CI: 1.16 - 1.65, p < 0.001) compared to length of stay of ≤2 days. (Figure 1A) Overall complication rate of 4% was noted. Cardiac complications were most common. Predictors of complications (odds ratio=OR, 95% confidence interval= CI, p-value) were diabetes (OR:1.50, CI-1.18-1,92, p<0.001), heart failure (OR:1.44, CI:1.12-1.85, p=0.005), peripheral vascular disease (OR:2.62, CI-1.87-3.69, p<0.001) and anemia (OR:2.02, CI-1.45-2.80, p<0.001). (Figure 1B)
Conclusion: Identification of high risk population based on certain pre-existing conditions can have improved outcomes in patients undergoing AFL ablation.