Po-02-072 high comorbidity burden is not associated with increased risk of periprocedural pericardial effusion during left atrial ablation procedures

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. Incidence of pericardial effusion (PE), a dreaded, potentially life-threatening complication that is associated with catheter ablation, has not been analyzed in larger cohorts stratified by CHA2DS2-VASc. Determine incidence of PE and drained PE related to left-atrial (LA) procedures in billing data between 2010 and 2021 of a large tertiary-care ablation center in Germany. Eligible cases of LA procedures were identified via analysis of billing data between 2010 and 2021. Analysis accounted for different versions of the ICD-10-GM and OPS-ICHI catalogues. Comorbidities and occurrences of complications were defined as derived variables from documented ICD-10 and OPS codes. CHA2DS2-VASc was calculated from derived variables and demographic parameters (age and sex). 8396 LA-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, PE occurred in 21/1867 (1.1%) cases. Here, 10/21 (48%) required drainage. Occurrence of PE did not differ between CHA2DS2-VASc stratified groups (χ2 p=0.805). PE requiring drainage was not different petween groups (χ2 p=0.822). Patients with a higher comorbidity burden undergoing catheter ablation for AF in the past 10 years were not subject to an increased risk for PE 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 will be provided.