Impact of Atrial Fibrillation Ablation on Recurrent Hospitalization: A Nationwide Cohort Study

Objectives: This study assessed the impact of atrial fibrillation (AF) ablation on hospitalization and antiarrhythmic drug use in the community setting. Background: Despite the widespread increase in the use of catheter ablation to treat AF in the United States, the impact of ablation on arrhythmic, cardiovascular, and noncardiovascular hospitalizations remains unclear. Methods: The national prospectively acquired Truven Health MarketScan data set (January 1, 2008 to December 31, 2014) was used to identify patients who underwent first time AF ablation with uninterrupted enrollment for 24 months (12 months pre-ablation and 12 months post-ablation). Multivariate logistic regression was used to determine predictors of hospitalization. Results: Of 5,238 patients who underwent AF ablation for the first time, 2,720 patients with uninterrupted enrollment were analyzed (age 60 ± 10 years; 29% were women, 79% had hypertension, and 23% had heart failure [HF]). AF ablation was associated with significantly reduced all-cause hospitalization from 1,669 hospitalizations in the year before ablation to 1,034 hospitalizations in the year after ablation, which was driven primarily by a 56% reduction in arrhythmic hospitalization. Nonarrhythmic cardiovascular hospitalizations also declined through a 43% drop off in HF hospitalizations. Noncardiovascular hospitalization rates did not significantly change. Age younger than 55 years (odds ratio [OR]: 1.43; p < 0.001), obstructive sleep apnea (OR: 1.38; p < 0.001), and HF (OR: 1.29; p = 0.024) were multivariate predictors for decreased arrhythmic hospitalization. Rates of antiarrhythmic drug use also significantly declined post-procedure by 37.5% (p < 0.001). Conclusions: In this nationwide cohort, AF ablation was associated with significant decreases in arrhythmic and nonarrhythmic cardiovascular hospitalizations, which was driven by reductions in hospitalization for AF and HF.