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CAlifornia Study of ABLation (CAABL): Utilization and Epidemiology after Index Hospitalization for non-valvular Atrial Fibrillation.

Catheter ablation (ABL) for non-valvular AF (NVAF) is recommended for symptomatic patients refractory to medical therapy and the success of ABL is related to the duration of the arrhythmia prior to intervention. Our aim was to assess the early utilization and the factors that prompted ABL in patients hospitalized for new onset NVAF. Using de-identified administrative discharge records for hospitalizations and emergency department (ED) visits, we determined the patients who had a first-time (since 1991) health record diagnosis of AF between 2005 - 2011. We linked ambulatory surgery encounters for ABL based on ICD 9 code occurring within two years of initial hospitalization. After excluding other cardiac arrhythmias, atrio-ventricular nodal ablation or pacemaker/defibrillator placement and cardiac valve disease, bivariate comparisons were made with those who did not undergo ABL. During the study period, 3,440 of 424,592 patients (0.81%) hospitalized for new onset NVAF underwent ABL. Parameters significantly (p<0.001) associated with ABL compared to non-ABL patients included: principal diagnosis of AF (55% vs 25%), age 35-64 yrs (46.1% vs. 22.4%), male (58.9% vs. 48.2%), private insurance (46.6% vs. 21.1%), Caucasian (81.0% vs.71.6%), lower frequency of ED visit < 6 months before index AF hospitalization (10.7% vs. 15.9%), lower severity of illness (major or extreme) at time of AF diagnosis (16.5% vs. 35.6%) and a lower prevalence of major comorbidities (p< 0.001). Ablation has low utilization for treatment of new onset NVAF within two years of diagnosis. Earlier utilization of ABL may reduce health care burden related to NVAF and requires further evaluation.

Credits: Uma Srivatsa MBBS, MAS, FACC, FHRS, Beate Danielsen PhD, Ezra Amsterdama MD, Yingbo Yang MD PhD, Dali Fan MD,Nayereh Pezeshkiana MD, MPH, Richard H White MD

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