Aims In-hospital complications of catheter ablation for atrial fibrillation (AF),
atrial flutter (AFL), and ventricular tachycardia (VT) may be overestimated by analyses
of administrative data.Methods and results We determined the incidences of in-hospital
mortality, major bleeding, and stroke around AF, AFL, and VT ablations in four German
tertiary centres between 2005 and 2020. All cases were coded by the G-DRG- and OPS-systems.
Uniform code search terms were applied defining both the types of ablations for AF,
AFL, and VT and the occurrence of major adverse events including femoral vascular
complications, iatrogenic tamponade, stroke, and in-hospital death. Importantly, all
complications were individually reviewed based on patient-level source records. Overall,
43 031 ablations were analysed (30 361 AF; 9364 AFL; 3306 VT). The number of ablations/year
more than doubled from 2005 (n = 1569) to 2020 (n = 3317) with 3 times and 2.5 times
more AF and VT ablations in 2020 (n = 2404 and n = 301, respectively) as compared
to 2005 (n = 817 and n = 120, respectively), but a rather stable number of AFL ablations
(n = 554 vs. n = 612). Major peri-procedural complications occurred in 594 (1.4%)
patients. Complication rates were 1.1% (n = 325) for AF, 1.0% (n = 95) for AFL, and
5.3% (n = 175) for VT. With an increase in complex AF/VT procedures, the overall complication
rate significantly increased (0.76% in 2005 vs. 1.81% in 2020; P = 0.004); but remained
low over time. Following patient-adjudication, all in-hospital cardiac tamponades
(0.7%) and strokes (0.2%) were related to ablation. Major femoral vascular complications
requiring surgical intervention occurred in 0.4% of all patients. The in-hospital
mortality rate adjudicated to be ablation-related was lower than the coded mortality
rate: AF: 0.03% vs. 0.04%; AFL: 0.04% vs. 0.14%; VT: 0.42% vs. 1.48%.Conclusion Major
adverse events are low and comparable after catheter ablation for AFL and AF (similar
to 1.0%), whereas they are five times higher for VT ablations. In the presence of
an increase in complex ablation procedures, a moderate but significant increase in
overall complications from 2005-20 was observed. Individual case analysis demonstrated
a lower than coded ablation-related in-hospital mortality. This highlights the importance
of individual case adjudication when analysing administrative data. Graphical Abstract
