AF Ablation complication spreadsheet

A while back, I promised Shannon I would put something together comparing major complications from the different classes of centers. Cappato et al did a world wide survey of tertiary referral centers (even amongst them, many would only do paroxysmal AF). Deshmukh et al did a analysis of a wide variety of private pay and medicare centers. Lastly, Winkle just looked at the medicare data only. Unfortunately, different authors used their own jargon to describe the complication. Where there is commonality, I would fill in the spreadsheet. Because not all complication descriptions are common, there are blanks. I used Cappato et al classification as the complication descriptor so if there is data, it will be Cappato's tertiary centers. The format does not transfer over in cut-and-paste and I apologize for that but you should be able to make it out. If not, let me know and I can clarify from my spreadsheet. Everything is in percentage of patients.

Ok, still not aligned perfectly but a lot better than the first try (thanks George).

AF Ablation complication data From Cappato, Deshmukh and Winkle et al.					
Type of Complication		Cappato Data, %	Deshmukh data,%	Medicare, bottom 50%	Medicare, Overall
Death		                        0.15	0.42	0.65	0.4
Tamponade	                 	1.31	2.54	3.15	3.1
Pneumothorax		                0.09	0.39	0.55	0.4
Hemothorax	                 	0.02			
Sepsis, abscesses, or endocarditis	0.01			
Permanent diaphragmatic paralysis	0.17			
Total femoral pseudoaneurysm		0.93	total vascular below	total vascular below	total vascular below
Total artero-venous fistulae		0.54	5.8	5.7	5.7
Valve damage/requiring surgery		0.07	0.28	0.4	0.4
Atrium-esophageal fistulae	       0.04			
Stroke		                               0.23	stroke + TIA below	0.4	0.4
Transient ischemic attack	       0.71	1.02	                        0.3	0.2
PV stenoses requiring intervention	0.29			
Total		                                4.54	6.28	9.15	9.1

Edited 3 time(s). Last edit at 08/20/2015 03:14PM by researcher.

Researcher,

This may help your formatting issue. I've put an extra space after the [ when I've written [ code] and [ /code] so the program will display these tags.

Monospaced, formatted code: [ code]...[ /code] You can also use spaces within the this to space things. I've used this and used preview to iterate to a solution that looks correct.

Sometimes, you might have things like ASCII art, programming code, guitar TABs, etc., which you want to put in your message. For those cases, you can use the [ code] tag. Example:

[ code]

 _____  _
|  __ \| |
| |__) | |__   ___  _ __ _   _ _ __ ___
|  ___/| '_ \ / _ \| '__| | | | '_ ` _ \
| |    | | | | (_) | |  | |_| | | | | | |
|_|    |_| |_|\___/|_|   \__,_|_| |_| |_|

[ /code]

Without the [ code] around it, this would look totally scrambled, like:

_____ _
| __ \| |
| |__) | |__ ___ _ __ _ _ _ __ ___
| ___/| '_ \ / _ \| '__| | | | '_ ` _ \
| | | | | | (_) | | | |_| | | | | | |
|_| |_| |_|\___/|_| \__,_|_| |_| |_|

Example from the BBcode help from pressing the ? in the upper right of the entry screen.

George

See first post ... edited.



Edited 1 time(s). Last edit at 08/20/2015 03:10PM by researcher.

Thanks Researcher,
The Desmukhs data for those who may not be familiar is from the large review of all Medicare cases from 2000 to 2010 that included all 93,801 U.S. Medicare ablation patients durung that period, and the overall significant increase in most complications noted in that study reflect the fact that >81% of all of these patients were ablated by greenhorn EPs doing less than 25 procedures a year and at small low volume centers or hospitals doing under 50 total AFIB ablations a year !!

And Desmukhs emphasizes our core message so often reinforced strongly on our forum and newsletter urging those needing an ablation to be very discriminating in who they choose as the complication rates broken down by upper 19% or so of higher volume operators show progressively much lower such complications, especially the really serious adverse events, with the greater the experience of the operator ... no surprise there.

The majority of ablationist out there are reasonably safe, but the odds of getting one of those with a very consistently safe and effective track record increase in direct proportion to their experience level, almost invariably.

Shannon



Edited 1 time(s). Last edit at 08/25/2015 12:40PM by Shannon.