In a 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.
Key Findings
Results
The vast majority of AF catheter ablations in the US are performed at centers with on-site cardiothoracic surgery, with only a small minority done at centers without it.
Among 81,471 patients undergoing AF ablation, 96.7% were treated at centers with on-site CTS.
Only 3.3% of patients were treated at centers without on-site CTS.
Data were drawn from the National Readmissions Database (NRD) from 2016 to 2021.
On-site CTS was defined by the performance of coronary artery bypass graft surgery at the hospital.
Results
Patients treated at centers without on-site cardiothoracic surgery had a higher baseline risk profile than those treated at centers with CTS.
Patients at non-CTS centers were older and more frequently female.
Patients at non-CTS centers had a higher comorbidity burden.
Patients at non-CTS centers had greater thromboembolic risk.
Multivariable logistic regression was used to adjust for these demographic and clinical covariates in outcome analyses.
Results
On-site cardiothoracic surgery availability was not independently associated with in-hospital mortality after multivariable adjustment.
Multivariable logistic regression was used to assess the association between on-site CTS and outcomes.
The analysis adjusted for demographic and clinical covariates.
No statistically significant independent association was found between CTS availability and in-hospital mortality.
This finding held in a cohort of 81,471 patients across 2016–2021.
Results
On-site cardiothoracic surgery availability was not independently associated with serious procedural complications including cardiac perforation, pericardiocentesis, or need for open heart surgery.
After multivariable adjustment, CTS availability was not associated with cardiac perforation.
CTS availability was not associated with pericardiocentesis rates.
CTS availability was not associated with the need for open heart surgery.
These are among the most feared complications of catheter ablation that have historically justified the CTS requirement.
Results
On-site cardiothoracic surgery availability was not independently associated with vascular, pulmonary, or neurological complications.
After multivariable adjustment, no significant association was found between CTS availability and vascular complications.
No significant association was found between CTS availability and pulmonary complications.
No significant association was found between CTS availability and neurological complications.
These findings were consistent across a national sample spanning six years (2016–2021).
Results
On-site cardiothoracic surgery availability was not independently associated with discharge disposition or 30-day all-cause readmissions.
After multivariable adjustment, CTS availability was not associated with likelihood of discharge to home.
CTS availability was not associated with 30-day all-cause readmission rates.
30-day readmissions were assessed using the National Readmissions Database, which tracks patients across hospital visits.
Multivariable logistic regression was used for all outcome analyses.
What This Means
This research suggests that having open-heart surgery capabilities available at the same hospital where a patient undergoes catheter ablation for atrial fibrillation (a procedure to correct abnormal heart rhythms) does not appear to meaningfully affect patient safety outcomes. Using a large national database of over 81,000 patients treated between 2016 and 2021, the researchers found no significant difference in rates of death, serious complications (such as heart perforation or bleeding around the heart), or hospital readmission within 30 days between hospitals that had on-site cardiothoracic surgery and those that did not — after accounting for differences in patient characteristics.
Historically, guidelines and safety recommendations have emphasized that catheter ablation for atrial fibrillation should only be performed at centers capable of emergent surgical intervention, based on the assumption that rare but life-threatening complications could require immediate open-heart surgery. However, this study reflects contemporary practice (2016–2021), during which ablation techniques and peri-procedural care have substantially improved, potentially reducing the rate and severity of such complications to the point where immediate surgical backup may be less critical.
This research suggests that the longstanding requirement for on-site cardiothoracic surgery may warrant reassessment in light of modern procedural safety data, potentially allowing more hospitals — including those in underserved or rural areas — to offer AF ablation. However, the findings should be interpreted with the caveat that centers without on-site surgery represented only 3.3% of cases, and the patients treated there tended to be older and sicker, which may have influenced the results in complex ways even after statistical adjustment.
Agarwal S, Patel H, Asad Z, Munir M, Munoz F, DeSimone C, et al.. (2026). Impact of On-Site Cardiothoracic Surgery Availability on Outcomes of Catheter Ablation for Atrial Fibrillation in the United States.. Journal of cardiovascular electrophysiology. https://doi.org/10.1111/jce.70495