Outpatient ablation for atrial fibrillation

Jiménez‐Candil, Javier; Perez, Jendri; Hernández, Jesús; Moríñigo, José Luis; García, Manuel Sánchez; Sánchez, Pedro L.

doi:10.1016/j.rec.2020.10.009

Cited by 2 publications

(7 citation statements)

References 6 publications

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“…We present the broadened results of the first systematic outpatient AF ablation programme, performed in the Spanish Public Health System. 7 According to our findings, the SDD strategy allows the vast majority of patients to be discharged within <12 h of hospitalization, without increasing the incidence of unplanned or urgent medical attention 10 days after discharge. Both the CRYO and RF ablation procedures present virtually identical feasibility and safety profiles.…”

Section: Discussionmentioning

confidence: 60%

“…Our previously published experience based on a prospective comparison of two AF ablation strategies (with homogeneous protocols in which the only difference was hospitalization after the procedure) showed that SDD is safe because it does not increase the incidence of UUC-10. 7 However, there are little data comparing CRYO vs. RF in this context. The results from the Canadian series, comprised mostly of patients treated with RF (80%) and some ( n = 82) with CRYO, present a similar level of safety for both energies.…”

Section: Discussionmentioning

confidence: 99%

“…Our protocol for outpatient AF ablation has been previously described. 7 In brief, patients underwent a left atrial angio-computed tomography (CT) before their first PVI to rule out the presence of a thrombus in the left atrium and to determine the anatomy of the left atrium and pulmonary veins. Before redo PVI, the presence of thrombus in the left atrial appendage was excluded by transoesophageal echocardiography.…”

Section: Methodsmentioning

confidence: 99%

“…As previously reported, the average cost in this period was 1372€ [95% confidence interval (CI): 1303–1440] per procedure. 7 …”

Section: Methodsmentioning

confidence: 99%

“…Several research groups have reported their results on outpatient AF ablation, with the rate of feasibility ranging from 60 to 90%. 7–11 However, there are little prospective data comparing the two mostly used PVI strategies [cryoballoon (CRYO) and radiofrequency (RF) catheter ablation] on cost analyses. Here, we present our findings on the feasibility, safety, and cost of hospital resource use when using CRYO vs. RF ablation in a systematic programme of same-day discharge (SDD) after PVI.…”

Section: Introductionmentioning

confidence: 99%

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Clinical and economic outcomes of a systematic same-day discharge programme after pulmonary vein isolation: comparison between cryoballoon vs. radiofrequency ablation

Jimenez-Candil,

Hernandez Hernandez,

Cruz Galban

et al. 2023

Europace

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Structured Abstract Background and Aims Same-day discharge (SDD) is feasible after pulmonary vein isolation (PVI). We aim to compare prospectively cryoballoon (CRYO) versus radiofrequency (RF) ablation in a systematic SDD program. Methods We prospectively analyzed the 617 scheduled PVI performed consecutively at our institution (n = 377 CRYO, n = 240 RF) from April 1, 2019 to December 31, 2022 within a systematic program of SDD. The feasibility of SDD, the 10-day incidence of urgent/unplanned medical care after discharge (UUC-10), and the cost per procedure due to hospital resource use were studied. The 100 procedures performed during the previous year, in which patients were systematically hospitalized, were used as a control group. Results SDD was achieved in 585/617 (95%) procedures, with a significant trend towards a higher monthly SDD rate from 2019 to 2022 (p = 0.03). The frequency of SDD was similar in CRYO (356/377; 94%) vs. RF (229/240; 95%). After SDD, the UUC-10 was 66/585 (11.3%), being similar for CRYO (41/356; 11.5%) and RF (25/229; 10.9%); p = 0.8 (log-rank test). Of these, 10 patients were re-hospitalized, with an identical rate in CRYO- (6/356; 1.7%) and RF-treated (4/229; 1.7%) patients and owing to similar causes (4 hematomas, 4 pericarditis, and 2 symptomatic sinus node dysfunction). SDD was associated with an average savings per procedure of 63% (p < 0.001), but no differences were found between the CRYO and RF (p = 0.8). Conclusions In a systematic SDD program, feasibility (95%, increasing over time), safety (11% UUC-10, 1.7% re-hospitalizations), and savings (63% per procedure) were similar for CRYO and RF ablation.

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Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…As previously reported, the average cost in this period was 1372€ [95% confidence interval (CI): 1303–1440] per procedure. 7 …”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Clinical and economic outcomes of a systematic same-day discharge programme after pulmonary vein isolation: comparison between cryoballoon vs. radiofrequency ablation

Jimenez-Candil,

Hernandez Hernandez,

Cruz Galban

et al. 2023

Europace

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Effectiveness and Safety of an Outpatient Program for Percutaneous Left Atrial Appendage Occlusion

Blanco-Fernández,

Antúnez-Muiños,

Núñez-García

et al. 2023

JCM

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Background: Left atrial appendage occlusion (LAAO) is a safe and effective alternative to oral anticoagulation for thromboprophylaxis in patients with nonvalvular atrial fibrillation. Technological development in devices and imaging techniques, as well as accumulated experience, have increased procedural success rates and decreased complications. Same-day discharge protocols have been proposed in the field of structural heart disease, but this approach has not been studied in detail for the LAAO procedure. Aim: The aim of this study is to assess the safety and efficacy of an outpatient program for LAAO when compared to the conventional treatment approach. Methods: We present a retrospective, non-randomized single-center study of 262 consecutive patients undergoing LAAO. Patients were divided into two groups, the first (n = 131) followed a conventional protocol (CP), and the second (n = 131) an outpatient protocol (OP). The primary composite endpoint comprised MACCE (death, stroke, and bleeding), cardiac tamponade, vascular complication, or attendance in the emergency department after hospital discharge at 30 days. Results: The overall success rate was 99.6%, with a periprocedural complication rate of 2.29%. With regards to the CP versus OP group, there were no differences between incidences of the primary composite endpoint (6.1% PC vs. 3.0% PA, p = 0.24), or after an analysis, with propensity score matching. No differences were observed in the individual endpoints. There was a decrease in hospital length of stay in the same-day discharge group (p < 0.01). Conclusions: A same-day discharge LAAO program is safe, effective, and feasible when compared to the conventional strategy. Moreover, it reduces hospital length of stay, which might have clinical and economic benefits.

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Outpatient ablation for atrial fibrillation

Cited by 2 publications

References 6 publications

Clinical and economic outcomes of a systematic same-day discharge programme after pulmonary vein isolation: comparison between cryoballoon vs. radiofrequency ablation

Clinical and economic outcomes of a systematic same-day discharge programme after pulmonary vein isolation: comparison between cryoballoon vs. radiofrequency ablation

Effectiveness and Safety of an Outpatient Program for Percutaneous Left Atrial Appendage Occlusion

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