In a nationwide Japanese registry study of 412,947 elective atrial fibrillation ablation procedures, in-hospital mortality was 0.029% with a modest but statistically significant decline over time, and no evidence of a diffusion-related safety penalty was observed during rapid procedural expansion.
In-hospital mortality following elective atrial fibrillation ablation was 0.029% across 412,947 procedures in Japan from 2012 to 2022.
Annual procedural volume of elective AF ablation increased nearly 6-fold from 10,969 procedures in 2012 to 63,014 procedures in 2022.
In-hospital mortality showed a modest but statistically significant declining trend over the study period despite rapid procedural expansion.
Within 30 days of the procedure, deaths occurred both during the index hospitalization and during readmission.
Low institutional procedural volume was independently associated with more than twice the odds of in-hospital mortality compared to higher-volume centers.
Higher comorbidity burden was strongly and independently associated with in-hospital mortality after elective AF ablation.
The study used a validated nationwide administrative database to overcome limitations of prior registry and administrative data on AF ablation mortality.
This research examined the safety of a common heart procedure — catheter ablation for atrial fibrillation (an irregular heart rhythm) — during a period when the procedure became much more widely performed in Japan. Using data from over 412,000 procedures performed between 2012 and 2022, the researchers found that the risk of dying in the hospital after this elective procedure was very low, at about 3 in 10,000 cases (0.029%). Importantly, this death rate did not increase as more hospitals began performing the procedure and annual volumes nearly tripled; in fact, there was a slight but statistically meaningful decline in mortality over time. The study also identified which patients faced the greatest risk. People with multiple serious health conditions (high comorbidity scores), older patients, those with lower body weight, and patients treated at lower-volume hospitals were at higher risk of dying. Cardiac tamponade — a life-threatening condition where fluid builds up around the heart — was the most common complication found alongside in-hospital deaths, occurring in about 1 in 5 of those who died. Patients in better functional health before the procedure had dramatically lower odds of dying. This research suggests that the rapid expansion of AF ablation in Japan has not come at the cost of patient safety, countering concerns raised by some earlier studies using different data sources that suggested mortality rates could be up to 10 times higher or were worsening over time. The finding that lower-volume hospitals have more than double the mortality risk compared to higher-volume centers may have implications for how healthcare systems organize and concentrate specialized cardiac procedures.
Inoue K, Kanaoka K, Ueda Y, Abe H, Ikeoka K, Mishima T, et al.. (2026). Periprocedural Mortality Risk After Elective Atrial Fibrillation Ablation in Japan.. JAMA network open. https://doi.org/10.1001/jamanetworkopen.2026.34516