Background Complications are a measure of procedural quality, yet variation in complication rates following catheter ablation of atrial fibrillation (AF) among hospitals has not been systematically examined. We examined institutional variation in the risk-standardized 30-day complication rates (RSCRs) following AF ablation which may suggest variation in care quality. Methods and Results This cohort study included all patients >18 years old undergoing AF ablations from 2012 to 2017 in Australia and New Zealand. The primary outcome was procedure-related complications occurring during the hospital stay and within 30 days of hospital discharge. We estimated the hospital-specific risk-standardized complication rates using a hierarchical generalized linear model. A total of 25 237 patients (mean age, 62.5±11.4 years; 30.2% women; median length of stay 1 day [interquartile range, 1-2 days]) were included. Overall, a complication occurred in 1400 (5.55%) patients (4.34% in hospital, 1.46% following discharge, and 0.25% experienced both). Bleeding (3.31%), pericardial effusion (0.74%), and infection (0.44%) were the most common complications while stroke/transient ischemic attack (0.24%), cardiorespiratory failure and shock (0.19%), and death (0.08%) occurred less frequently. Among 46 hospitals that performed ≥25 ablations during the study period, the crude complication rate varied from 0.00% to 21.43% (median, 5.74%). After adjustment for differences in patient and procedural characteristics, the median risk-standardized complication rate was 5.50% (range, 2.89%-10.31%), with 10 hospitals being significantly different from the national average. Conclusions Procedure-related complications occur in 5.55% of patients undergoing AF ablations, although the risk of complications varies 3-fold among hospitals, which suggests potential disparities in care quality and the need for efforts to standardize AF ablation practices among hospitals.
Keywords: atrial fibrillation; catheter ablation; complication; institutional variation.