Prospective implementation of a same-day discharge protocol for catheter ablation of paroxysmal atrial fibrillation

Abstract

Purpose Overnight stays associated with catheter ablation (CA) for paroxysmal atrial fibrillation (PAF) account for a significant proportion of treatment cost. Same-day discharge (SDD) after CA may be attractive to both patients and hospitals, especially in light of current restrictions on overnight stays due to COVID-19. This study reports on the selection criteria, protocol, and safety of SDD after CA of PAF. Methods Patients undergoing CA for PAF were evaluated to assess the risk of groin, respiratory, cardiac, or bleeding complications. SDD eligibility criteria were stable anticoagulation with no bleeding history, systolic heart failure, respiratory conditions, or interventional procedures within 60 days, and recommended BMI < 35. Patient proximity to the hospital was also considered. Anesthesia with propofol was used, and ablations were performed with a contact force catheter. Patients rested for 6 h postprocedure and then ambulated over 1-2 h. Discharge followed if they were stable without evidence of complications. A nurse called all patients the following morning to elicit evidence of complications. Results Of 44 planned SDD procedures between April 2017 and June 2018, 41 resulted in SDD after 7.2 ± 1.0 h, 2 patients stayed overnight for observation, and one by choice. Average age was 59 ± 10 years with CHA 2 DS 2-VASc of 1.6 ± 1.1. No SDD-related complications occurred, and no return visits resulted from the follow-up calls. Conclusion Appropriate low-risk patients identified by well-defined clinical criteria can be safely discharged the same day after CA for PAF. Evaluation in a larger population across different centers is required for generalizability of this SDD protocol.

Evaluating outcomes of same-day discharge after catheter ablation for atrial fibrillation in a real-world cohort

“…Although the selection and discharge criteria vary by study, the success rate of SDD has been suggested to be between 79.1% and 99.2%, among patients who meet the criteria for SDD. 10 , 15 , 16 , 17 , 18 The reasons for not achieving SDD could be varied. A recent chart review of 426 patients following implementation of the SDD strategy after elective outpatient CA for AF or left atrial flutter showed that 50 patients (12%) were not discharged same day.…”

“… 17 The SDD protocol usually includes procedure on the morning list (end before 2 PM), procedure occurred without complications, no evidence of complications after ambulation, stable hemodynamics, and purse-string suture removed. 10 , 16 , 18 To assess the postprocedural outcomes, our study identified a selective cohort of patients without complications on the date of index CA procedure and during the observation period and no consecutive inpatient admission after the CA procedure. We further matched the SDD group with a comparable ONS group using PSM by considering important covariates that could potentially affect the outcomes of interest.…”

“…We further excluded patients who had complications during the index CA admission, because patients who had periprocedural complications were more likely to have ONS, 17 and SDD protocol usually requires a that procedure occurred without complications. 10 , 16 , 18 For patients who had any postprocedural complication identified, we examined whether those patients had repeat ablation before the date of complication recorded and within 30 days after the index ablation. If present, we excluded them because the identified postprocedural complication could have been associated with either the index or repeat CA.…”

“…CA typically involves follow-up observation for at least 1 overnight stay (ONS) in the outpatient setting 9 ; however, a growing body of evidence suggests that it may be feasible and safe to discharge appropriately selected patients home on the same day of their procedure. 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 The same-day discharge (SDD) approach has been increasingly utilized.…”

A prospective multi-site registry of real-world experience of catheter ablation for treatment of symptomatic paroxysmal and persistent atrial fibrillation (Real-AF): design and objectives

“…However, this is also a particular strength of the study. It will allow for a description of different techniques, like same-day discharges, by which participating centers have circumvented these challenges [38]. Examinations of the impact of volume interruptions on operator skills and procedural outcomes will be possible.…”