Utilization and complications of catheter ablation therapy for cardiac arrhythmias in congenital heart disease: a retrospective cross-sectional study.

BACKGROUND: Catheter ablation is a cornerstone in arrhythmia management, but its safety profile in patients with congenital heart disease (CHD) remains underexplored on a national scale. OBJECTIVES: To evaluate the utilization and in-hospital complication rates of catheter ablation among patients with CHD and arrhythmias, using data from a large, nationally representative inpatient database. METHODS: We analyzed data from the 2018-2020 National Inpatient Sample (NIS) to identify hospitalizations involving catheter ablation for arrhythmias in adult CHD patients. Patient characteristics, in-hospital outcomes, and resource utilization were examined. Multivariable logistic regression was used to identify predictors of complications. RESULTS: Between 2018 and 2020, 2370 adult hospitalizations for CHD involved catheter ablation for cardiac arrhythmias. Most patients were aged 60-74 years (41%), male (61%), and White (80%). Atrial fibrillation (44%) and atrial flutter (34%) were the most common indications. In-hospital mortality was low at 0.6%. Median length of stay was 3.0 days (IQR: 2.0-6.0), and the median inflation-adjusted total charge was $138 056 (IQR:$99 076-$202 284). Twelve percent of patients experienced at least one complication, most commonly pericardial, vascular, and cardiac complications. In multivariate analysis, ablation for atrial flutter was associated with increased odds of at least one complication (OR: 3.32 [1.44-7.62]; P = 0.005). Age ≥75 years was associated with lower odds compared with age 18-44 years (OR: 0.22 [0.05-0.94]; P = 0.042). Gender, race, insurance, income, and comorbidities were not significantly associated with in-hospital complications. CONCLUSION: In this nationally representative cohort of adults with CHD undergoing catheter ablation, in-hospital mortality and complication rates were low. However, complication risk varied by arrhythmia type and age, reiterating the need for individual risk assessment and continued evaluation of procedural safety. The lower complication rate in the oldest age group likely reflects selection bias rather than greater intrinsic procedural safety. CHD complexity, surgical-scar-related arrhythmia substrates, and chromosomal abnormalities are underexplored but clinically meaningful determinants of ablation outcomes that warrant dedicated investigation in future registry-based studies.