Cardiac Tamponade and/or Pericardiocentesis Following Atrial Fibrillation

Measure Specification

Cardiac tamponade is one of the most serious complications of atrial fibrillation ablation that can lead to substantial morbidity due to a significant drop in the cardiac output and blood pressure leading to hypo-perfusion of important organs such as the brain, heart, and kidneys. In many cases, cardiac tamponade has to be treated surgically, and it invariably prolongs hospital stay.

If not treated promptly, cardiac tamponade can lead to death. The risk of this dreaded complication has been reported to range from 2 to 6%; however, these rates were observed in tertiary referral centers where the procedure was performed by experienced and skillful operators. Given that the occurrence of cardiac tamponade is largely dependent on the operator’s level of experience and, therefore, is in most cases preventable, higher rates are expected to occur when less experienced operators perform the procedure.

These issues prove the need to measure performance in this area.

In recognition that there is an absence of applicable physician-level performance measures for the profession of cardiac electrophysiology, the Heart Rhythm Society (the international professional society focused on the care of patients with heart rhythm disorders) convened a Performance Measures Development Task Force to consider and develop potential physician-level measures cardiac electrophysiologists.

The task force consisted of thought leaders in atrial fibrillation ablation, cardiovascular health policy, performance measures development, clinical outcomes, and population science. The process for consideration of the evidence included review of multi-stakeholder professional society clinical expert consensus statements on the topic, such as the 2012 Heart Rhythm Society/European Heart Rhythm Association/European Cardiac Arrhythmia Society Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation (Calkins et al, 2012), and the relevant literature both referenced within this document and in the knowledge of the members of the task force (Cappato et al, 2005; Hsu et al, 2005; Andrade et al, 2011; Bunch et al, 2005; Cappato et al, 2009; Cappato et al, 2010; Cappato et al, 2011; Fisher et al, 2000; Hsu et al, 2003; Latchamsetty et al, 2011; O’Neill et al, 2008; Tsang et al, 2002).

The expert consensus statement does not provide a specific recommendation related to this proposed outcome measure, but rather summarizes that in high-volume and high-quality programs, the incidence of complications in general should be comparable to the low rates of complications observed in published studies, including the world- wide survey of atrial fibrillation ablation (Cappato et al, 2005; Cappato et al, 2009; Cappato et al, 2010; Cappato et al, 2011).

Collectively, the incidence of this complication has in general ranged from between 1.2 and 2.4% across the literature evaluated (Cappato et al, 2005; Hsu et al, 2005; Calkins et al, 2012; Andrade et al, 2011; Bunch et al, 2005; Cappato et al, 2009; Cappato et al, 2010; Cappato et al, 2011; Fisher et al, 2000; Hsu et al, 2003; Latchamsetty et al, 2011; O’Neill et al, 2008; Tsang et al, 2002).

This measure contains four strata defined by four submission criteria. This measure produces five performance rates. There are four Submission Criteria for this measures: 1) Females 18-64 years of age AND 2) Males 18-64 years of age AND 3) Females 65 years of age and older AND 4) Males 65 years of age and older This measure will be calculated with 5 performance rates: 1) Females 18-64 years of age 2) Males 18-64 years of age 3) Females 65 years of age and older 4) Males 65 years of age and older 5) Overall percentage of patients with cardiac tamponade and/or pericardiocentesis occurring within 30 days MIPS eligible clinicians should continue to submit the measure as specified, with no additional steps needed to account for multiple performance rates.

For accountability reporting in the CMS MIPS program, the rate for Submission Criteria 5 is used for performance. For the purposes of MIPS implementation, this patient-process measure is submitted a minimum of once per patient for the performance period. The most advantageous quality data code (QDC) will be used if the measure is submitted more than once.

This is an inverse measure which means a lower calculated performance rate for this measure indicates better clinical care or control. The “Performance Not Met” numerator option for this measure is the representation of the better clinical quality or control. Submitting that numerator option will produce a performance rate that trends closer to 0%, as quality increases.

For inverse measures, a rate of 100% means all of the denominator eligible patients did not receive the appropriate care or were not in proper control. Include only patients that have had atrial fibrillation ablation performed by November 30, 2026 for evaluation of cardiac tamponade and/or pericardiocentesis occurring within 30 days within the performance period.

This will allow the evaluation of cardiac tamponade and/or pericardiocentesis complications within the performance period. A minimum of 30 cases is recommended by the measure owner to ensure a volume of data that accurately reflects provider performance; however, this minimum number is not required for purposes of QPP submission.