Trends in safety of catheter-based electrophysiology procedures in the last 2 decades: A meta-analysis

Connor P Oates; Binaya Basyal; William Whang; Vivek Y Reddy; Jacob S Koruth

doi:10.1016/j.hrthm.2024.03.043

Trends in safety of catheter-based electrophysiology procedures in the last 2 decades: A meta-analysis

Heart Rhythm. 2024 Apr 16:S1547-5271(24)00355-2. doi: 10.1016/j.hrthm.2024.03.043. Online ahead of print.

Authors

Connor P Oates¹, Binaya Basyal², William Whang³, Vivek Y Reddy³, Jacob S Koruth⁴

Affiliations

¹ MedStar Heart and Vascular Institute, Georgetown University-Washington Hospital Center, Washington, DC; Helmsley Center for Cardiac Electrophysiology, Icahn School of Medicine at Mount Sinai, New York, New York.
² MedStar Heart and Vascular Institute, Georgetown University-Washington Hospital Center, Washington, DC.
³ Helmsley Center for Cardiac Electrophysiology, Icahn School of Medicine at Mount Sinai, New York, New York.
⁴ Helmsley Center for Cardiac Electrophysiology, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: jacob.koruth@mountsinai.org.

PMID: 38752906
DOI: 10.1016/j.hrthm.2024.03.043

Abstract

Background: Rapid technologic development and expansion of procedural expertise have led to widespread proliferation of catheter-based electrophysiology procedures. It is unclear whether these advances come at cost to patient safety.

Objective: This meta-analysis aimed to assess complication rates after modern electrophysiology procedures during the lifetime of the procedures.

Methods: A comprehensive search was performed to identify relevant data published before May 30, 2023. Studies were included if they met the following inclusion criteria: prospective trials or registries, including comprehensive complications data; and patients undergoing atrial fibrillation ablation, ventricular tachyarrhythmia ablation, leadless cardiac pacemaker implantation, and percutaneous left atrial appendage occlusion. Pooled incidences of procedure-related complications were individually assessed by random effects models to account for heterogeneity. Temporal trends in complications were investigated by clustering trials by publication year (2000-2018 vs 2019-2023).

Results: A total of 174 studies (43,914 patients) met criteria for analysis: 126 studies of atrial fibrillation ablation (n = 24,057), 25 studies of ventricular tachyarrhythmia ablation (n = 1781), 21 studies of leadless cardiac pacemaker (n = 8896), and 18 studies of left atrial appendage occlusion (n = 9180). The pooled incidences of serious procedure-related complications (3.49% [2000-2018] vs 3.05% [2019-2023]; P < .001), procedure-related stroke (0.46% vs 0.28%; P = .002), pericardial effusion requiring intervention (1.02% vs 0.83%; P = .037), and procedure-related death (0.15% vs 0.06%; P = .003) significantly decreased over time. However, there was no significant difference in the incidence of vascular complications over time (1.86% vs 1.88%; P = .888).

Conclusion: Despite an increase in cardiac electrophysiology procedures, procedural safety has improved over time.

Keywords: Cardiac electrophysiology; Catheter ablation; Leadless pacemaker; Meta-analysis; Outcomes; Safety.