Pau, Dhaval

Introduction: Atrial flutter ablation has been increasingly offered as first line therapy and has been safely performed over the past few decades. However, limited data exists regarding current utilization and trends in adverse outcomes arising from this procedure. The aim of our study was to examine the frequency of adverse events attributable to atrial flutter (AFL) ablation and the influence of hospital volume on safety outcomes. Hypothesis: We hypothesize an association between hospital volume and adverse outcomes. Methods: With the use of the Nationwide Inpatient Sample, we identified 89,638 AFL patients treated with catheter ablation from 2000-2011. We investigated common complications including cardiac perforation and tamponade, pneumothorax, stroke, transient ischemic attack, vascular access complications, and in-hospital death. We defined these complications by using validated International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. Results: The overall frequency of complications was 3.17%, with combined cardiac complications (1.44%) being the most frequent. Cardiac complications were followed by vascular complications (0.78%), respiratory complications (0.88%), and neurological complications (0.05%). The in-hospital mortality was 0.17%. Low hospital volume (<50 procedures) was significantly associated with increased adverse outcomes. In addition, there was a small, insignificant rise in overall complication rates over time. Conclusions: The overall complication rate was 3.17% in patients undergoing AFL ablation. There was a significant association between low hospital volume and increased adverse outcomes. This suggests a need for future research into identifying the safety measures in AFL ablations and instituting appropriate interventions to improve overall AFL ablation outcomes.

Introduction: Short-term use of Mechanical Circulatory Support (MCS) has the potential to benefit the patients undergoing Transcatheter Aortic Valve Replacement (TAVR) who may be high-risk or suffer complications. The present study was conducted to address the contemporary use of MCS in TAVR procedures. Methods: The study included a total of 1794 TAVR procedures in the years 2011-2012 from Nationwide Inpatient Sample (NIS) database. Use of MCS was identified using ICD-9-CM codes. The patients were divided based on use of MCS devices. The primary outcome of the study was in-hospital mortality and the secondary outcomes were complications, length of stay (LOS) and cost. Multi-variate simple logistic regression models were used to identify independent predictors of the outcomes. Results: Out of total 1794 TAVR procedures, 190 (10.6 %) utilized a MCS device (MCS group) and 1,604 (89.4%) did not (non-MCS group). The use of MCS devices with TAVR was associated with increase in the in-hospital mortality (14.9% vs. 3.5%, p<0.01) with same results obtained in multi-variate models. The rates of complications were significantly higher in MCS group so as the mean length of stay (11.8±0.8 vs. 8.1±0.2 days, p<0.01) and cost ($68,997±3,656 vs. $55,878±653, p=0.03). Conclusion: Use of MCS in TAVR predicts increase in-hospital mortality, complications, LOS and cost of care.