Early Mortality after Inpatient versus Outpatient Catheter Ablation in Patients with Atrial Fibrillation

[www.heartrhythmjournal.com]

I think it can happen as documented, especially to the 122,289 patients that underwent CA for treatment of AF between 2016-2019 that this study defined a 30-day mortality in both inpatients and outpatients.

I woke up above ground today but in 2021 after my third ablation, I was transferred to the ICU where the ICU doctor told me to get my affairs in order because my heart stopped/paused every 2-10 minutes from 4-15 seconds of flatlining. That week contributed to my high 54 ecv count. I had 8 ecvs during the ablation. I continued getting sinus pauses for days until I had a pacemaker implanted.

I don’t think the study should be discounted because it was during during a 2016-2019 period compared to the technology of today. One can still have Iatrogenic hiccups.

Inpatients are sick people. That's why they're inpatients. So it's no surprise that they have a higher mortality rate.

The impressive finding from that study is the significantly lower mortality rate at high-volume centers. We've been preaching here for years that if you seek an ablation, you need an EP who has done thousands of ablations at a center that does thousands of ablations. Personally, I don't believe ablations should be performed at smaller, low-volume centers at all.

I agree Carey.

I think what we can say is, that all procedures on the heart are complex and sometimes complicated, and unfortunately people can die. I agree that choosing the best you possibly can will surely put the odds on your favour.

I’ve had two ablations and a few CVS and 8 months of glorious SR with some small hiccups. Now, over the last couple of months I’ve had a mixture of AF and a very fast heart rate which is freaking me out. My EP is the best and the centre has an amazing safety record, but at my age I will probably just live with it.

We should remember there are people who cannot afford to pay the high cost of travel, accomodation, and specialists fees. Those living in poverty, on limited pensions, no medical insurance etc; are the people who miss out on having the very best treatment on offer.

There would have to be a meta-analysis of the determinations of death if autopsies were performed. Is age a co-factor, BMI/weight, co-morbidities such as lung disorders, hypertension, metabolic diseases, metabolic syndrome, full-blown diabetes (especially Type 1 that has been poorly managed over the years, or Type 2 that is also not being well controlled), ...we could add another 20 problems that might coincidentally have presented at the same time as the AF, and simply had become terminal over the ensuing days or two/three weeks.

It really IS complicated.

And to Joy's point, how sobering it is for me that there are so very many who wouldn't afford themselves the luxury of ruing their penury as their time would be so much better spent doing something else. I hate how the word 'privilege' has become so poorly political, but the idea behind its recent inclusion in politics isn't lost on me. Some of us are lucky simply because we were born to people with means, and who managed to keep us on the paths that led us to build on, or to at least maintain, the power of that ethic and its various salutary products.