Temporal trends in safety and complication rates of catheter ablation for atrial fibrillation

Muthalaly, Rahul G.; John, Roy M.; Schaeffer, Benjamin; Tanigawa, Shin‐ichi; Nakamura, Tomofumi; Kapur, Sunil; Zei, Paul C.; Epstein, Laurence M.; Tedrow, Usha B.; Michaud, Gregory F.; Stevenson, William G.; Koplan, Bruce A.

doi:10.1111/jce.13484

Cited by 66 publications

(61 citation statements)

References 16 publications

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“…A recent study on catheter ablation in AF patients suggested increasing proportion of patients with OSA undergoing catheter ablation for AF in the modern era cohort (2014‐2015) when compared with historic cohort (2009‐2011). These findings suggest that these coexistences remain an ongoing issue in the modern era …”

Section: Introductionmentioning

confidence: 82%

“…These findings suggest that these coexistences remain an ongoing issue in the modern era. 14 Continuous positive airway pressure (CPAP) is a well-known, effective therapy for OSA. Several studies have demonstrated favorable effects of CPAP therapy on preventing arrhythmias recurrence, heart rate control in patients with AF, and in decreasing severity and/or frequency of ventricular extrasystoles 3,7,13,15 Although the exact mechanism of CPAP use improves the success of AF treatment remains unclear, it has been suggested to be due to a reduction of the structural and electrical remodeling of the left atrium and oxidative stress, resulting in a lower recurrence rate of AF.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Effect of obstructive sleep apnea and its treatment of atrial fibrillation recurrence after radiofrequency catheter ablation: A meta‐analysis

Congrete

Bintvihok

Thongprayoon

et al. 2018

J Evidence Based Medicine

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Section: Introductionmentioning

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Effect of obstructive sleep apnea and its treatment of atrial fibrillation recurrence after radiofrequency catheter ablation: A meta‐analysis

Congrete

Bintvihok

Thongprayoon

et al. 2018

J Evidence Based Medicine

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“…The only complication observed among day‐cases was a right phrenic nerve palsy in a cryoballoon ablation: this well‐known risk is usually a transient phenomenon and indeed it had resolved on patient return to the ward, allowing same‐day discharge as planned. As an expectation of a low complication rate is critical while planning for wide adoption of a day‐case ablation strategy, it is notable that a decrease in AF ablation complication rates overall has been observed lately . This is particularly the case with the increasing use of ultrasound for vascular access, as vascular complications are by far the most common and those most likely to preclude early mobilization and same‐day discharge.…”

Section: Discussionmentioning

confidence: 99%

Same‐day discharge in selected patients undergoing atrial fibrillation ablation

Bartoletti

Mann

Gupta

et al. 2019

Pacing Clinical Electrophis

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Background Atrial fibrillation (AF) ablation is a complex procedure, generally requiring at least one overnight hospital stay. We investigated the safety and feasibility of early mobilization and same‐day discharge following streamlined peri‐ablation management for AF. Methods From 2014, we offered same‐day discharge to selected patients who underwent uncomplicated AF ablation on the morning lists, with ultrasound‐guided femoral access, uninterrupted warfarin or minimal interruption in novel oral anticoagulants, and reversal of intraprocedural heparin with protamine. Patients were discharged 6‐8 h postprocedure and offered access to a dedicated nurse helpline. Results Of 1599 AF ablation cases performed from April 2014 to March 2017, 811 (50.7%) were performed on the morning lists and 169/811 (20.8%) were discharged on the same day. Excluding 26 research cases, 1/143 (0.7%) had transient right phrenic nerve palsy and five (3.5%) cases experienced minor problems that did not preclude same‐day discharge; three (2.1%) needed rehospitalization postdischarge: one for pericarditic chest pain and two for nausea/vomiting. Compared to 642 overnight cases, day‐case procedures were shorter, more likely to be redos, to be performed under sedation rather than general anesthesia, and less likely to involve linear lesions and electrical cardioversion. There were no significant differences in patient age, gender, body mass index, CHA2DS2‐VASc, in preprocedural anticoagulation regimen (warfarin vs novel anticoagulants vs no anticoagulation) and in choice of ablation method (cryoballoon vs radiofrequency). Conclusions Selective same‐day discharge after AF ablation is safe and feasible using a streamlined peri‐procedural care protocol. Wider adoption can potentially reduce health‐care costs while improving patient experience.

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“…Cardiac tamponade is a common, potentially life‐threatening complication during radiofrequency ablation of atrial fibrillation (RAAF) and must be addressed in a timely manner 1–3 . Pericardiocentesis is used to relieve the tamponade in the vast majority of patients.…”

Section: Introductionmentioning

confidence: 99%

“…Cardiac tamponade is a common, potentially life-threatening complication during radiofrequency ablation of atrial fibrillation (RAAF) and must be addressed in a timely manner. [1][2][3] Pericardiocentesis is used to relieve the tamponade in the vast majority of patients. If patients show hemodynamic stability and no sign of pericardial bleeding, the pericardial drain can be removed.…”

Section: Introductionmentioning

confidence: 99%

Early versus delayed removal of the pericardial drain in patients with cardiac tamponade complicating radiofrequency ablation of atrial fibrillation

Zhao

Liu

et al. 2020

Cardiovasc electrophysiol

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Introduction Cardiac tamponade is a common life‐threatening complication during radiofrequency ablation of atrial fibrillation (RAAF) and is mostly managed by pericardiocentesis. Thus far, the optimal timing for drain removal has not been established. Methods and Results We retrospectively enrolled patients with cardiac tamponade complicating RAAF. The ablation was performed with interrupted novel oral anticoagulants, interrupted warfarin or uninterrupted warfarin protocols. An observation period of at least 30 minutes after the last aspiration via the drain was used to monitor the reaccumulation of pericardial fluid, and then, the patients were divided into an early removal (ER) group in the electrophysiology (EP) laboratory and a delayed removal (DR) group in the ward. A total of 51 patients were included: 25 patients in the ER group and 26 patients in the DR group. There were no significant differences in baseline demographics between the two groups, and no cardiac tamponade reoccurred in either group in the ward. Unlike the DR group, the ER group showed an association with a decreased rate of chest pain (P = .000), fever (P = .001), nausea (P = .000), in‐hospital recurrent AF (P = .010), and antibiotic use (P = .012). Anticoagulation was earlier (P = .009), and the median in‐hospital stay was shorter (P = .001) in the ER group than in the DR group. Conclusions ER of the pericardial drain after no evidence of pericardial bleeding for at least 30 minutes in the EP laboratory is safe and associated with a better early hospital course.

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Temporal trends in safety and complication rates of catheter ablation for atrial fibrillation

Abstract: The safety profile of AF ablation has improved significantly in less than a decade.

Cited by 66 publications

References 16 publications

Effect of obstructive sleep apnea and its treatment of atrial fibrillation recurrence after radiofrequency catheter ablation: A meta‐analysis

Effect of obstructive sleep apnea and its treatment of atrial fibrillation recurrence after radiofrequency catheter ablation: A meta‐analysis

Same‐day discharge in selected patients undergoing atrial fibrillation ablation

Early versus delayed removal of the pericardial drain in patients with cardiac tamponade complicating radiofrequency ablation of atrial fibrillation

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