Efficacy and safety of same-day discharge after atrial fibrillation ablation compared with post-procedural overnight stay: a systematic review and meta-analysis

Abstract

Aims Catheter ablation for atrial fibrillation (AF) has historically required inpatient admission post-procedure, but same-day discharge (SDD) has recently been reported. We aimed to assess the efficacy and safety of SDD compared with overnight stay (OS) post-ablation. Methods and results We performed a systematic search of the PubMed database. Random-effects meta-analysis was performed to assess the efficacy (successful SDD) and safety (24 h complications, 30-day complications, 30-day re-admissions, and 30-day mortality) of a SDD AF ablation strategy. Fourteen non-randomized observational studies met criteria for inclusion, encompassing 26488 patients undergoing AF ablation, of whom 9766 were SDD. The mean age of participants was 61.9 years, and 67.9% were male. Around 61.7% underwent ablation for paroxysmal AF. The pooled success rate of SDD was 83.2% [95% confidence intervals (CIs): 61.5–97.0%, I2 100%]. The risk of bias was severe for all effect estimates due to confounding, as most cohorts were retrospectively identified without appropriately matched comparators. There was no significant difference in 30-day complications [odds ratio (OR): 0.95, 95% CI: 0.65–1.40, I2 53%] or 30-day re-admission (OR 0.96, 95% CI: 0.49–1.89, I2 82%) between groups. There were insufficient data for meta-analysis of 24 h complications and 30-day mortality. Where reported, no re-admissions occurred due to 24 h complications after SDD. Two deaths (0.04%) were reported in both SDD and OS groups. Conclusion Same-day discharge after AF ablation appears to be an effective and safe strategy in selected patients. However, the available evidence is of low quality, and more robust prospective studies comparing SDD to OS are needed.

Efficacy and safety of Proglide use and early discharge after atrial fibrillation ablation compared to standard approach. PROFA trial

“…In a meta-analysis of 14 non randomized trials, including more than 35.000 patients, Tang et al, 13 reported a success rate of same day discharge protocol in 83.2% patients, with no significant difference in 30-day complications or readmission, obtaining similar results as our study. In a similar way, Prasitlumkum et al, 14 showed no differences in total complications, comparing a same day discharge strategy compared to overnight stay.…”

Ambulatory pulmonary vein isolation workflow using the Perclose ProglideTM suture-mediated vascular closure device: the PRO-PVI study

“… 13 , 14 Existing data also support a potential for cost saving driven by a reduction in hospital costs, although there are little prospective controlled data available on this topic. 15 , 16 The advantages of using devices for vascular closure have already been assessed in the context of arterial procedures. 17 In particular, they were shown to reduce the rate of complication and the necessity of bedrest, shortening the total hospital stay.…”

Same-day discharge after atrial fibrillation ablation under a nurse-coordinated standardized protocol

“… 25 , 26 However, quantitative data in the context of catheter ablation are lacking. 27 Moreover, although again we cannot provide quantitative data, the feedback clearly indicates that the systematic interaction and patient education provided by the SDD coordinator and its function as a contact person increased patient satisfaction considerably. Finally, a systematic coordination of workflows and patient pathways, as well as standardized education and specific instructions provided by the SDD coordinator, might even have contributed to the compelling safety outcome.…”