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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Trend Analyses on Interventional Treatment of Atrial Fibrillation From 2016 to 2022: Insights From a Multicenter
Sebastian König1,2, Sven Hohenstein2, Johannes Leiner1,2
1Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany.
Insights
Catheter ablation (CA) for atrial fibrillation (AF) saw increased utilization from 2016-2022. The COVID-19 pandemic caused a temporary dip but did not alter the long-term upward trend in AF CA procedures.
Area of Science:
- Cardiology
- Interventional Cardiology
- Public Health
Background:
- Limited real-world data exists on atrial fibrillation (AF) catheter ablation (CA) utilization.
- The impact of the COVID-19 pandemic on interventional AF treatment trends is not well-documented.
Purpose of the Study:
- To analyze trends in AF catheter ablation (CA) case numbers and characteristics.
- To assess the influence of the COVID-19 pandemic on AF CA utilization.
Main Methods:
- Retrospective analysis of administrative data from 87 German hospitals (2016-2022).
- Inclusion of inpatient cases with AF diagnosis undergoing CA, identified via ICD-10 and OPS codes.
- Calculation of incidence-rate ratios (IRR) using negative binomial models to assess trends.
Main Results:
- A significant increase in AF CA case numbers was observed (IRR 1.05, p < 0.001).
- No sustained pandemic impact; a temporary 2020 decline occurred.
- Increased cryoablation ratio, decreased transesophageal echocardiography use, and reduced intensive care treatment.
Conclusions:
- AF CA case numbers rose significantly between 2016 and 2022.
- The COVID-19 pandemic did not disrupt the long-term upward trend in AF CA.
- Observed changes in CA management warrant further investigation.
Background:
Current real-world data on the utilization of atrial fibrillation (AF) catheter ablation (CA) are scarce, as is information on the impact of the COVID-19 pandemic on trends in interventional AF treatment. Aims of this study were to describe case characteristics and trends of CA management using a contemporary multicenter database.
Methods:
In this retrospective, cross-sectional analysis, we investigated administrative data provided by 87 German hospitals from 01/01/2016 to 12/15/2022. Based on ICD-10 and OPS codes, inpatient cases with a main or secondary discharge diagnosis of AF who underwent CA were extracted. Incidence-rate ratios (IRR) for case numbers with 95% confidence intervals (CI) were calculated using negative binomial models. Trends based on regression analysis were adjusted for baseline variables.
Results:
Analyzing 29 144 CA cases (89.4% from high-volume centers), a significant increase in case numbers was observed throughout the study period (IRR 1.05, 95% CI 1.03-1.07, p < 0.001). There was no sustained impact on the overall trend from the COVID-19 pandemic, but a temporary drop in case numbers in 2020. Utilization of transesophageal echocardiography (OR 0.82, 95% CI 0.81-0.83, p < 0.001) and intensive care treatment declined (OR 0.92, 95% CI 0.89-0.94, p < 0.001) and there was a trend toward a reduced incidence of pericardial tamponade. The ratio of cryoablations to radiofrequency CA case numbers increased from 0.29 ± 0.06 in 2016 to 0.50 ± 0.07 in 2022.
Conclusion:
We observed an increase in AF CA case numbers over the study period without a sustained influence of the COVID-19 pandemic on this long-term trend. Reported adaptations in CA management deserve further attention.
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