Abstract
Background
Atrial fibrillation catheter ablation (CA) is the most frequent arrhythmia ablation and accounts for a significant proportion of treatment cost. Same day discharge (SDD) after paroxysmal atrial fibrillation (PAF) ablation is an attractive strategy for both patients and hospitals.
Objective
To understand the eligibility criteria and outcomes for PAF patients who can safely undergo same day discharge after radiofrequency catheter ablation.
Methods
Patients undergoing CA for PAF were evaluated for SDD at a pre-procedure visit to assess the risk of groin, respiratory, cardiac or bleeding complications. Eligibility criteria for SDD were stable anticoagulation and absence of bleeding history, systolic/diastolic heart failure, or interventional procedures within 60 days, with recommended BMI <35. Patient proximity to the hospital was also considered. Anesthesia included propofol with endotracheal intubation and all patients were ablated with a porous tip contact force catheter (STSF). Patients were on bed rest for 6 hours post-procedure, then ambulated intermittently for 1–2 hours. Discharge followed if they were stable with no evidence of vascular access complications or bleeding. A dedicated RN telephoned patients the following morning to ask a series of standard questions designed to elicit evidence of any complications.
Results
52 procedures were identified for SDD, with 7 patients declining. 45 planned SDD procedures for 43 patients occurred 4/17–6/18. Average age was 57±11 years and CHA2DS2-VASc was 1.5±1.1 at procedure. Procedure time was 69±26 min (IQR: 49 - 84 min) with maximum fluoroscopy usage of 0.2 min and 508±149 mL of fluid infused through the catheter. Two patients stayed overnight due a groin bleed and atelectasis with fever, and one chose to stay for comfort. The remaining 42 discharges occurred after 7.2±1.0 hours in recovery, with no SDD-related complications and no required return visits after the follow-up call. There were 3 AF recurrences (6.7%) as of the 10 week visit.
Conclusion
Appropriate low risk patients identified by simple clinical criteria can be safely discharged the same day after CA of PAF. Further evaluation is required for higher risk patients.
Acknowledgement/Funding
The study was funded by Biosense Webster Inc.
Prospective implementation of a same-day discharge protocol for catheter ablation of paroxysmal atrial fibrillation
