Background: Catheter ablation is the most effective rhythm control treatment for atrial fibrillation (AF) and benefits of early rhythm control (ERC) were recently demonstrated to be enhanced in patients with a high comorbidity burden (CHA2DS2-VASc ≥ 4). Incidence of  pericardial effusion, a dreaded, potentially life-threatening complication that is associated with catheter ablation,has not been analyzed in larger patient cohorts stratified by CHA2DS2-VASc.
Purpose: To determine incidence of pericardial effusion and drained pericardial effusion related to left-atrial (LA) procedures in billing data between 2010 and 2021 of a large tertiary-care ablation center in Germany.
Method: Eligible cases of LA procedures were identified through analysis of coded OPS data between 2010 and 2021. This analysis included patients with atrial fibrillation undergoing an ablation procedure including a transseptal puncture and mapping in the left atrium, not for other supraventricular tachycardias. Analysis accounted for different versions of the ICD-10-GM and OPS-ICHI catalogues. Comorbidities and occurrences of complications were defined as derived variables on a case-wise analysis from documented ICD-10 and OPS codes. CHA2DS2-VASc-score was calculated from these derived variables and demographic parameters (age and sex).
Results: 8396 left atrial procedures in 6184 patients (35% female, 63.6±11.0 years old at index procedure) were analysed. Derived CHA2DS2-VASc was < 4 in 6529 (78%) and ≥ 4 in 1867 (22%) cases, median CHA2DS2-VASc was 2 (IQR 1;3) in the overall cohort. Non-paroxysmal AF was more prevalent in the CHA2DS2-VASc ≥ 4 group (62.5%) than in the overall cohort (56%) and in the CHA2DS2-VASc < 4 group (54%). Hypertension was the most common comorbidity in 5285 (63%) patients. Coronary artery disease was present in 1433 (17%), heart failure in 3757 (45%), chronic kidney disease in 899 (11%) patients, thereof 591 (7%) at a stage ≥ KDIGO III. Pericardial effusion was documented in 78/6529 (1.2%) in the CHA2DS2-VASc < 4 group. Thereof 35/78 (45%) required interventional or surgial drainage. In the CHA2DS2-VASc ≥ 4 group, pericardial effusion occurred in 21/1867 (1.1%) cases. Here, 10/21 (48%) required drainage. Occurrence of pericardial effusion did not differ between CHA2DS2-VASc-score stratified groups (χ2 p=0.805). Pericardial effusion requiring drainage was not different petween groups (χ2 p=0.822).
Conclusion: Patients with a higher comorbidity burden undergoing catheter ablation for atrial fibrillation in the past 10 years were not subject to an increased risk for pericardial effusion or drainage. This observation allows to perform highly efficient ablation procedures equally in patients with low and high comorbidity burden safely. Further analysis of the dataset regarding further left atrial ablation associated complications and their predictors will be provided.