Efficacy and safety of same‐day discharge after atrial fibrillation ablation: A systematic review and meta‐analysis

Abstract

Conventionally, patients have been admitted overnight after atrial fibrillation (AF) catheter ablation. Several centers have recently adopted a same-day discharge (SDD) protocol for patients undergoing AF catheter ablation. We aimed to systematically review the current evidence for the safety and efficacy of SDD after AF catheter ablation. A systematic search was performed in PubMed, Embase, Scopus, Web of Science, and the Cochrane library until August 21, 2021. The risk of bias was assessed with the "Methodological Index for Non-Randomized Studies" (MINORS).The pooled efficacy rate of SDD protocol (defined as the proportion of patients discharged the same day of ablation among the patients who were planned for SDD) was calculated. Meanwhile, pooled major complication rates and early readmission or emergency department (ED) visit rates were evaluated in successful and planned SDD groups separately. Overall, 12 observational studies consisting of 18,065 catheter ablations were included, among which 7320 (40.52%) were discharged the same-day after ablation. The pooled efficacy was 90.3% (95% confidence interval ). The major complication rates were 1.1% (95%CI [0.5-1.9]), and 0.7% (95% CI [0.0-3.1]) in planned SDD and successful SDD groups, respectively.In addition, readmission/ED visit rate were 3.0% (95%CI [0.9-6.1]), and 3.1% (95% CI [0.8-6.5]) in the same groups. There were no significant differences between planned SDD and overnight groups with respect to major complication rate (risk ratio = 0.70, 95%CI [0.35-1.42], p-value = .369). The available data indicates that SDD after AF ablation is safe and efficient. Further prospective and randomized studies are warranted to elucidate the safety of SDD after AF ablation and develop a standardized SDD protocol.

Same‐day discharge following catheter ablation and venous closure with VASCADE MVP: A postmarket registry

“…In an era of heightened concern about infectious disease transmission, reducing exposure to other patients by prompt hospital discharge may reduce risk. The safety and cost‐effectiveness of SDD after catheter ablation have been reported in numerous single‐center and multicenter cohorts, as well as in systematic reviews and meta‐analyses, dating back to at least 2010 5–8,14–16 …”

“…Same‐day discharge (SDD) following catheter ablation for AF may improve patients' experiences and reduce resource utilization, thereby lowering costs 2–4 . SDD has been shown to be safe with varied patient types and hospital discharge policies 2,4–8 …”

Randomized prospective evaluation of same-day discharge after cryoballoon ablation of atrial fibrillation: results of the EASY PVI study

“…Among twelve major studies, a review by Rashedi et al included 18,065 ablations, of which 7320 (40.52%) patients were discharged on the same day as their procedure. Major complications remained low 0.7-1.1% and readmission or emergency room visits were also about 3%, without statistically significant differences between SDD and overnight stay (ONS) groups [2]. A similar review by Prasitlumkum et al analyzing ten of the same studies did not find a significant difference in rate of complications [3].…”

Can all stakeholders benefit from same‐day discharge following catheter ablation of atrial fibrillation?

“…Many series have demonstrated the feasibility and safety of SDD. 7 However, the last piece needed for widespread and streamlining of this process was a better and shorter way than manual pressure to achieve and maintain hemostasis of the vascular access. This was provided by the introduction of Vascade MVP™ (Cardiva Medical) in late 2018.…”

“…The need for SDD has become more pronounced as the COVID‐19 pandemic occurred and bed occupancy was direly needed for the COVID‐19‐infected patients. Many series have demonstrated the feasibility and safety of SDD 7 . However, the last piece needed for widespread and streamlining of this process was a better and shorter way than manual pressure to achieve and maintain hemostasis of the vascular access.…”