Impact of Hospital VT Ablation Volume on Post-Procedural Complications: Argument for Selective Referral to High-Volume Centers.

Background: Existing studies have shown a relationship between hospital case volume and outcomes of various cardiovascular procedures. The impact of hospital procedure volume on complications of catheter ablation of ventricular tachycardia (VT) and the potential benefit of selective referral to high-volume centers have not been previously evaluated.

Objectives: This study sought to assess the associations between hospital procedure volume of VT catheter ablation and postprocedural morbidity and mortality.

Methods: The NIS (National Inpatient Sample) database was queried for hospital admissions for VT ablation in the United States during the year 2019. Hospitals were divided into tertiles of VT ablation volume (high-volume hospitals [HVH] ≥50 ablations per year, medium-volume hospitals performed 16-49 ablations, and low-volume hospitals [LVH] ≤ 15 ablations). Data on adverse events including in-hospital mortality and postprocedural complications were collected.

Results: Patients in HVH were more likely to have comorbidities including heart failure (74.3% vs 64.7%; P = 0.02) and kidney disease (25.3% vs 21.7%; P = 0.044) than LVH. After controlling for baseline confounders and with LVH as reference, HVH had lower in-hospital mortality (adjusted OR [aOR] = 0.80; 95% CI: 0.71-0.91; P = 0.04), cardiac tamponade (aOR = 0.58; 95% CI: 0.32-0.78; P = 0.01), and need for blood transfusion (aOR = 0.41; 95% CI: 0.21-0.68; P = 0.008). It can be estimated that for every 17 patients shifted from LVH to HVH, 1 death, cardiac tamponade, or major bleeding event could be prevented.

Conclusions: Patients undergoing VT ablation at HVH were sicker on average, yet had lower in-hospital mortality and procedure-related morbidity compared to LVH. Selective VT patient referral to HVH has the potential to substantially reduce in-hospital complications following VT ablation nationally.