Impact of On‐Site Cardiothoracic Surgery Availability on Outcomes of Catheter Ablation for Atrial Fibrillation in the United States

BACKGROUND: Catheter ablation is an established rhythm control strategy for atrial fibrillation (AF) but carries a small risk of serious complications that may require emergent surgical intervention. Historically, the availability of on-site cardiothoracic surgery (CTS) has been considered an important safety requirement. However, contemporary advances in ablation techniques and peri-procedural care have improved procedural safety, and real-world data evaluating the impact of on-site CTS availability in current practice remain limited. METHODS: We analyzed the National Readmissions Database (NRD) from 2016 to 2021 to identify adults undergoing catheter ablation for AF. Hospitals were classified based on the presence of on-site CTS, defined by the performance of coronary artery bypass graft surgery. Baseline characteristics were compared between groups. Multivariable logistic regression was used to assess the association between on-site CTS availability and in-hospital complications, mortality, discharge disposition, and 30-day all-cause readmissions, adjusting for demographic and clinical covariates. RESULTS: Among 81 471 patients undergoing AF ablation, 3.3% were treated at centers without on-site CTS and 96.7% at centers with CTS. Patients treated at centers without CTS were older, more frequently female, and had a higher comorbidity burden, including greater thromboembolic risk. After multivariable adjustment, on-site CTS availability was not independently associated with in-hospital mortality, cardiac perforation, pericardiocentesis, need for open heart surgery, vascular, pulmonary, or neurological complications, discharge to home, or 30-day readmissions. CONCLUSION: In this large, contemporary national cohort, the availability of on-site cardiothoracic surgery was not independently associated with improved peri-procedural or short-term outcomes following AF ablation.