Trends in utilization and complications of catheter ablation for atrial fibrillation in Medicare beneficiaries

BACKGROUND Utilization of radiofrequency catheter ablation (RFA) for treatment of atrial fibrillation (AF) is increasing. Data regarding the safety of RFA for AF outside of selected centers of excellence and in older patients are limited. OBJECTIVE The purpose of this study was to quantify utilization of RFA for treatment of AF and rates of adverse events over time in unselected U.S. Medicare patients. METHODS Using Medicare Provider Analysis and Review (MedPAR) files for fiscal years 2001-2006, we developed a coding algorithm to identify AF patients treated with RFA. The number of hospitals performing the procedure, the number of procedures performed, and the frequency of eight RFA complications were determined. The impact of patient characteristics on complication rates was assessed using multivariable logistic regression. RESULTS For fiscal years 2001 to 2006, the number of hospitals performing RFA for AF in Medicare patients increased from 100 to 162, and the annual total procedure volume increased from 315 to 1975 cases. The overall complication rate was 9.1%. Annual complication rates increased from 6.7% in 2001 to 10.1% in 2006 (P for trend = .01), mainly due to an increase in rates of vascular access complications. Increasing patient age was not associated with a higher complication rate. Hospital procedural volume was not associated with the overall risk of complications but was associated with the probability of in-hospital death. CONCLUSION For fiscal years 2001-2006, use of RFA for treatment of AF increased markedly in the Medicare population. Overall complication rates rose during this time, with perforation/tamponade and vascular access complications accounting for the majority of events.