Association of Case Volume With Ablation Outcomes in Children: Analysis of the NCDR IMPACT Registry

Increasing case volume has been positively associated with procedural outcomes in many fields, but little is known about this relationship for pediatric catheter ablation.

The objective of the study was to report associations between center and operator case volumes and acute success in pediatric ablations.

A multicenter retrospective cohort study of patients undergoing ablation at Improving Pediatric And Adult Congenital Treatment registry sites from April 2016-March 2020 was performed evaluating the association between center or operator annual case volume (low, medium, high, or very high) and the likelihood of acute ablation success. Unadjusted comparisons and multivariable logistic regression was completed with subgroup analyses to evaluate associations in higher risk subgroups.

Of 18,666 ablations at 74 hospitals, acute success was reported in 17,204 (92%). High/very high-volume centers showed marginal but statistically insignificant increases in the rates of acute success when compared to medium/low centers (92% vs 91%; P = 0.24). In multivariable models high volume centers saw increased odds of success in patients with congenital heart disease (OR: 2.3; CI: 1.21-4.4), and patients with premature ventricular contractions/ventricular tachycardia (OR: 2.2; CI: 1.23-4.1). Among 156 operators, the highest rates of acute success were seen in very high-volume operators (94%) compared to low (92.4%), medium (91.9%), and high (92.2%) operators (P = 0.015). Multivariable modeling showed no association between operator volume and acute success.

Pediatric catheter ablation acute success was high across a range of center and operator volumes. Complex substrates have increased odds of success at high volume centers, and high and very high-volume centers have consistent rates of success despite increasing case complexity.