Same day discharge after atrial fibrillation ablation is feasible and safe. Results of a prospective study in 1015 patients

Abstract Background Atrial fibrillation (AF) ablation is the standard treatment for symptomatic paroxysmal and persistent AF. It is a common practice for patients to stay overnight after the ablation for observation of possible complications. Thus, increasing volume of procedures places a significant strain on institutions. To tackle this issue, our institution developed a same-day discharge (SDD) protocol for AF ablation. Purpose To assess the feasibility and safety of the SDD protocol after at least four-hour observation in patients undergoing radiofrequency ablation (RFA) for AF. Methods A SDD protocol was implemented in our institution in March 2019. We conducted a prospective observational study that included all consecutive patients who underwent ablation for AF until January 2021. A detailed workflow setup provided in the figure. To compare means the Mann Whitney U test, and for categorical variables – χ2 test were used. The difference was significant when p<0.05. Results A total of n=1015 patients underwent RFA in the study period. Of those, same-day discharge was feasible in n=751 (74.1%) and n=264 stayed overnight. The mean age (SDD 62.5 SD 8.8 years vs overnight-stay 64.1 SD 9.2 years, p=0.105) and gender distribution (males SDD 46.8% vs overnight-stay 39.8%, p=0.265) did not differ between the two groups. In the SDD group no patients were readmitted for complications within 24 hours after the ablation. A severe complication was defined as pericardial effusion with drainage, pulmonary oedema, thromboembolic event and vascular complication needing surgical intervention. In total 3.0% of all patients experienced a severe complication. The main reasons for staying overnight were small groin hematoma without intervention (18.9%), nausea (14.4%) and logistic issues (32.2%). The 30-day hospital readmission rate was insignificantly higher in the overnight-stay group (19.4% vs 28.0%, p=0.113). The most common reasons for readmission were arrhythmias (SDD 10.1% vs overnight-stay 20.5%) and chest pain (SDD 7.6% vs overnight-stay 2.4%). One late pericardial effusion with drainage on day 10 after the ablation was noted in the SDD group. Conclusion Same-day discharge in patients after RFA for AF is feasible and safe with an observational period of at least four hours and immediate transthoracic echocardiography after the procedure. FUNDunding Acknowledgement Type of funding sources: None.

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Abstract 13720: Safety of Same-day Discharge for Atrial Fibrillation Ablation: A Systematic Review and Meta-analysis

Circulation ◽

10.1161/circ.142.suppl_3.13720 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Khawaja H Akhtar ◽

Khadija N Sami ◽

Muhammad H Khan ◽

Ali H Jafry ◽

Amna M Chaudhary ◽

...

Keyword(s):

Atrial Fibrillation ◽

Observational Studies ◽

Meta Analysis ◽

Vascular Complications ◽

Cost Effective ◽

Atrial Fibrillation Ablation ◽

Forest Plot ◽

Overnight Stay ◽

Same Day Discharge ◽

Ischemic Attack

Introduction: We evaluated the safety of same-day discharge in patients undergoing atrial fibrillation ablation procedure. Methods: A systematic search was conducted on 05/05/2020 by 2 independent researchers in MEDLINE, EMBASE and other databases for studies comparing the safety of same-day discharge versus overnight stay for patients undergoing atrial fibrillation ablation. No randomized controlled trials met the inclusion criteria, so observational studies were included in the analysis. Mantel-Haenszel risk ratios (random effects model) were calculated and for heterogeneity I 2 statistics were reported. Results: A total of 5 observational studies with 5018 patients were included. There was a non-statistically significant trend towards repeat 30 day hospital visits associated with same-day discharge as compared with overnight stay (RR=1.92, CI 0.44-8.32, p=0.39) (Figure-1). There were no differences between same-day discharge vs overnight stay in other outcomes including vascular complications (RR=1.24, CI 0.48-3.23), cardiac tamponade (RR=1.01, CI 0.15-6.60), stroke/transient ischemic attack/thromboembolic complications (RR=0.88, CI 0.05-16.19) and mortality (RR=1.03, CI 0.05=19.36) (Figure-1). Conclusion: Same day discharge after atrial fibrillation ablation is safe and has the potential to be a cost-effective strategy. Randomized trials are needed to validate these results. Figure-1: Forest plot of outcomes with same-day discharge vs overnight stay for patients undergoing atrial fibrillation ablation.

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P1865Incidence and predictors of invasively-treated pericardial effusion during catheter ablation of atrial fibrillation in Japan

European Heart Journal ◽

10.1093/eurheartj/ehz748.0615 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

Y Murakawa ◽

T Yamane ◽

M Goya ◽

K Inoue ◽

S Naito ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Pericardial Effusion ◽

Multiple Logistic Regression Analysis ◽

Heart Rhythm ◽

Multiple Logistic Regression ◽

Af Ablation ◽

Clinically Significant ◽

Artery Disease ◽

Gender Type

Abstract Purpose and method Japanese Heart Rhythm Society requested electrophysiology centers to register the data of patients who underwent catheter ablation for atrial fibrillation (AF) in designated eight months from 2011 to 2017. We assessed the incidence and predictors of pericardial effusion (PE) as an early complication of AF ablation. Results More than two hundred EP centers reported the data of 13,233 AF ablation cases (age; 64.2±10.7 years, male; 72.6%, paroxysmal AF; 63.4%). Clinically significant complications occurred in 601 subjects (4.5%). Critical PE occurred in 116 patients (0.8%), while six of them required open-chest surgery. Overall complication rate did not show significant changes. In contrast, incidence of PE declined over time (2012:1.2%, 2017:0.5%, p=0.003). Multiple logistic regression analysis showed that seven factors were related with higher incidence of PE. Among these factors, primary extra-PV ablation and hypertrophic cardiomyopathy (HCM) were more remarkably associated with higher rate of PE (PVI[−] vs. PVI[+]= 9.0% vs. 0.8%, OR 12.3, p<0.001; HCM: [+] vs. [−] = 2.6% vs. 0.8%, OR 3.26, p=0.001). Comorbidity of coronary artery disease (CAD) and use of CARTO system were related with lower PE rate (CAD: [+] vs [−] = 0.2% vs. 0.9%, OR 0.22 [p=0.034], CARTO: [+] vs [−] = 0.7% vs. 1.2%, OR 0.52 [p=0.001]). None of cryobaloon ablation, gender, type of AF, center volume, periprocedural oral anticoagulant, or left atrial diameter was significantly related with the occurrence of PE. Conclusions Incidence of critical PE decreased recently. HCM and primary extra-PV ablation were outstanding predictors of critical PE.

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Cryoablation: safety of same day discharge

European Heart Journal ◽

10.1093/eurheartj/ehab724.0537 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

M Carrington ◽

P Silverio Antonio ◽

A Nunes-Ferreira ◽

T Rodrigues ◽

N Cunha ◽

...

Keyword(s):

Hospital Stay ◽

Statistical Significance ◽

Early Discharge ◽

Complication Rates ◽

Af Ablation ◽

Overnight Stay ◽

Same Day Discharge ◽

Tertiary Center ◽

Low Rate

Abstract Introduction Discharge after overnight hospital stay is standard procedure in patients submitted to elective atrial fibrillation (AF) ablation. Taking into consideration the low rate of cryoablation procedure complications could the same day discharge be an option? Purpose To assess the safety of same day discharge of patients submitted to AF cryoablation. Methods Single-center retrospective study of consecutive patients admitted to elective AF cryoablation in a tertiary center between February 2017 and November 2020. Patients were divided into two groups: same day discharge and next day discharge. Only patients submitted to ablation until 4 p.m. were included. Complication rates were obtained up to six months after the procedure. Complications were defined as death, pericardial tamponade, hematoma requiring evaluation and/or intervention, major bleeding requiring transfusion, hospital admission related to the procedure. Results One hundred fifty-four patients were included, with a mean age of 61±10.9 years, 66.2% were males, 18.2% with diabetes, 65.6% with dyslipidemia, 77.9% with hypertension, 10.4% with chronic kidney disease KDIGO stage 3 or more. Median follow-up of 436 [178 – 729] days. Most of the patients had paroxysmal (73.4%) and persistent short duration AF (23.4%). Sixty-two patients (40.3%) were early discharged and there were no differences between the two groups regarding epidemiological and clinical characteristics (p=NS). A very low rate of complications in both groups was observed, occurring in 6.5% of patients with early discharge and in 8.7% of patients in overnight stay, without statistical significance between the two groups (p=0.61). The most frequent complications were local hematoma (5 patients, 2 in early discharged group), pericardial effusion (3 patients, all in overnight stay), femoral pseudo-aneurism (2 patients, 1 in each group) and arteriovenous fistula (1 patient in overnight stay group). The type of complications did not differ between the two groups (p=0.51). Two patients died during follow up, and this was unrelated to the procedure. In addition, no difference in success rate and arrhythmic recurrence was observed between the two groups (p=NS). Conclusion Our study suggests that it is safe to early discharge patients submitted to AF ablation, reducing the hospital stay length in selected patients. Larger studies are needed to confirm this data before routine implementation of this strategy. FUNDunding Acknowledgement Type of funding sources: None.

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P2831Safety of atrial fibrillation catheter ablation in the elderly

European Heart Journal ◽

10.1093/eurheartj/ehz748.1141 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

N Karim ◽

A Marinelli ◽

E Cantor ◽

V Boyalla ◽

K Malaczynska-Rajpold ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Pericardial Effusion ◽

Radiofrequency Catheter Ablation ◽

Invasive Procedure ◽

The Elderly ◽

Published Data ◽

Patient Records ◽

Complication Risk ◽

The Difference

Abstract Background Catheter ablation for drug refractory, symptomatic atrial fibrillation (AF), is becoming increasingly common and can be beneficial in alleviating symptoms. However, in the elderly, there are concerns about the risks an invasive procedure poses, with limited published data available in those aged over 80 years. Purpose To determine the complication risk of AF catheter ablation in the elderly Methods Complications were identified from patient records in 3156 consecutive patients who underwent radiofrequency catheter ablation for AF, at a tertiary cardiology centre between 2013–2017. All cases were performed under general anesthesia. Results In this cohort of 3156 patients (mean age= 62.9±11.0 years, female = 29.9%), 90 (2.85%) (mean age= 66±10.0 years, female = 49.5%) complications were identified. In patients aged ≥80 years, complications occurred in 5 out of 99 patients (5.05%) (mean age= 82.6±1.2, female=100%), compared to 85 out of 3057 patients (2.78%) in those aged <80 years (mean age= 65±10.3, female = 49.4%). The difference was not significant p=0.18. Complications in the elderly all occurred acutely, and included groin haematoma (2.02%), pneumonia (2.02%) and pericardial effusion (1.01%). Conclusion Catheter ablation for AF in patients ≥80 years of age, is not associated with a significant increase in complication risk, compared to those who are younger.

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Comparison between same‐day discharge and overnight stay after atrial fibrillation ablation: systematic review and meta‐analysis

Pacing and Clinical Electrophysiology ◽

10.1111/pace.14380 ◽

2021 ◽

Author(s):

Narut Prasitlumkum ◽

Wisit Cheungpasitporn ◽

Ronpichai Chokesuwattanaskul ◽

Jakrin Kewcharoen ◽

Nithi Tokavanich ◽

...

Keyword(s):

Atrial Fibrillation ◽

Systematic Review ◽

Meta Analysis ◽

Atrial Fibrillation Ablation ◽

Overnight Stay ◽

Same Day Discharge

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ProGlide venous closure device facilitates early ambulation following cryoablation of atrial fibrillation

EP Europace ◽

10.1093/europace/euab116.221 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

G Wong ◽

D Ahmed ◽

A Creta ◽

S Honarbakhsh ◽

V Kanthasamy ◽

...

Keyword(s):

Atrial Fibrillation ◽

Bleeding Complications ◽

Closure Device ◽

Minor Bleeding ◽

Early Ambulation ◽

Af Ablation ◽

Patient Pathways ◽

Same Day Discharge ◽

Significant Difference

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Heart Foundation Background Same-day discharge following atrial fibrillation (AF) ablation is increasingly common. ProGlide device suture-mediated vascular closure (PD) offers a technique that may expedite mobilisation following large-bore (>12F) venous access. The utility of PD closure following cryoablation of AF has not been reported. Purpose We sought to evaluate haemostasis and early ambulation outcomes in patients receiving the ProGlide compared with conventional techniques. Methods 104 consecutive patients undergoing cryoballoon pulmonary vein isolation (PVI) for paroxysmal or persistent at a single high-volume institution were included. PVI was performed via a standardised approach including sedation, ultrasound-guided vascular access for 14F Cryosheath and second 7F sheath, anticoagulation protocol, transeptal puncture, 28mm cryoballoon and nurse-led same-day discharge protocol. Haemostasis was achieved using the Perclose Proglide device (PD) in the 14F access point ("pre-closure" technique) plus 5 minutes manual pressure at the 7F sheath site. Alternatively, a figure-of-eight/Z-suture (ZS) was employed for closure according to operator preference. Protamine was used for heparin reversal in all patients. Safety outcomes of major bleeding, haematoma and minor bleeding were assessed. Time to ambulation (TTA), time to discharge (TTD), same-day discharge and complications at initial follow-up were measured. Results Overall, mean age was 64 ± 11 years, 65 (64%) were male and 52 (50%) of patients had paroxysmal AF, there were no significant differences between group demographics, with 31 patients (30%) in the PD group and 73 (70%) in the ZS group. All patients had uninterrupted oral anticoagulation throughout the periprocedural period. No major femoral bleeding complications requiring intervention occurred in either group. Haematomas occurred in none of the PD group compared with 2 (2.8%) in the ZS group. Incidence of minor bleeding was not significantly different between groups (PD: 3 [9.7%] vs ZS: 2 [2.7%], p = 0.155). Mean TTA was significantly shorter in the PD group (3.3 ± 1.1 vs 4.1 ± 1.7 hrs, p = 0.025). However, there was no significant difference in same-day discharge (PD: 25 [81%] vs ZS: 53 [73%], p = 0.386) and TTD (5.0 ± 3.6 vs 6.1 ± 4.2 hrs, p = 0.275) between groups. 1 patient complained of groin pain which delayed discharge in the ZS group not seen in the PD group. After a mean follow-up of 2.2 ± 1.4 months, there were no differences in major or minor complications. Conclusion Use of the Proglide closure device was associated with significant reductions in time to ambulation compared with Z-suture haemostasis following cryoablation of AF, and groin access complications were uncommon across groups. PD closure may contribute to further streamlining patient pathways in day-case AF ablation.

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Early discharge after cryoablation procedure: is it safe?

EP Europace ◽

10.1093/europace/euab116.181 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

P Silverio Antonio ◽

T Rodrigues ◽

J Brito ◽

S Pereira ◽

B Valente Silva ◽

...

Keyword(s):

Hospital Stay ◽

Statistical Significance ◽

Early Discharge ◽

Complication Rates ◽

Af Ablation ◽

Overnight Stay ◽

Same Day Discharge ◽

Tertiary Center ◽

Low Rate

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Discharge after overnight hospital stay is standard procedure in patients submitted to elective atrial fibrillation (AF) ablation. Taking into consideration the low rate of cryoablation procedure complications could the same day discharge be an option? Purpose To access the safety of same day discharge of patients submitted to AF cryoablation. Methods Single-center retrospective study of consecutive pts admitted to elective AF cryoablation in a tertiary center between February 2017 and November 2020. Patients were divided into two groups: same day discharge and next day discharge. Only patients submitted to ablation until 4 p.m. were included. Complication rates were obtained up to six months after the procedure. Complications were defined as death, pericardial tamponade, hematoma requiring evaluation and/or intervention, major bleeding requiring transfusion, hospital admission related to the procedure. Results One hundred fifty-four pts were included, with a mean age of 61 ± 10.9 years, 66.2% were males, 18.2% with diabetes, 65.6% with dyslipidemia, 77.9% with hypertension, 10.4% with chronic kidney disease KDIGO stage 3 or more. Median follow-up of 436 (IQ 178 – 729) days. Most of the pts had paroxysmal (73.4%) and persistent short duration AF (23.4%). Sixty-two pts (40.3%) were early discharged and there were no differences between the two groups regarding epidemiological and clinical characteristics (p = NS). A very low rate of complications in both groups was observed, occurring in 6.5% of pts with early discharge and in 8.7% of pts in overnight stay, without statistical significance between the two groups (p = 0.61). The most frequent complications were local hematoma (5 pts, 2 in early discharged group), pericardial effusion (3 pts, all in overnight stay), femoral pseudo-aneurism (2 pts, 1 in each group) and arteriovenous fistula (1 pt in overnight stay group). The type of complications did not differ between the two groups (p = 0.51). Two pts died during the follow up, unrelated with the procedure. In addition, no difference in success rate and arrhythmic recurrence was observed between the two groups. (p = NS) Conclusion Our study suggests that is safe to early discharge pts submitted to AF ablation, reducing the hospital stay length in selected pts. Larger studies are needed to confirm this data before routine implementation of this strategy.

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Same-day discharge for atrial fibrillation ablation: use of suture-mediated vascular closure device

EP Europace ◽

10.1093/europace/euab116.291 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

A Portoles-Hernandez ◽

J Toquero-Ramos ◽

S Garcia-Gomez ◽

V Castro-Urda ◽

E Garcia-Izquierdo ◽

...

Keyword(s):

Atrial Fibrillation ◽

Early Mobilization ◽

Phone Call ◽

Closure Device ◽

Vascular Closure Device ◽

Access Site ◽

Af Ablation ◽

Same Day Discharge ◽

Discharge Protocol

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The most frequent complications of atrial fibrillation (AF) ablation procedures are those related to the vascular access site, which are associated with increased morbidity and length of hospital stay. Purpose: To assess the safety and efficacy of venous access site closure with a suture-mediated vascular closure device (SVD), as well as the feasibility of early mobilization and same-day discharge protocol after AF ablation procedures. Methods: We conducted a retrospective analysis of all consecutive AF ablation patients in whom a SVD was employed to achieve hemostasis after each venous puncture. The ablation was performed under conscious sedation, using 7 to 12-F introducer sheaths. Anticoagulation was uninterrupted but for the last dose prior to the procedure. Intraprocedural heparin was not reversed. Groin ultrasound was performed in the first 10 patients with adequate SVD deployment. Three conditions were required for the same-day discharge protocol application: 1) uncomplicated procedure, 2) successful SVD deployment and 3) adequate recovery. Recovery followed a three-phase protocol: bed rest (two hours), sitting (one hour) and ambulation. Follow-up included phone call and clinical examination. Patients were offered contact to the electrophysiologist if needed. Results: 63 ablation procedures with SVD closure were performed from May 2019 to October 2020, with a total of 132 access sites analysed. Patient characteristics are shown in the table. The SVD was successfully deployed in 125 (94.7%) and hemostasis immediately achieved. In the remaining 5.3%, failure was attributed to a deficient technique, which missed to advance the knot to the vein. First 10 patients were ultrasound evaluated 24 hours later (no early discharge), showing total absence of complications. 35 subsequent patients (55.6% of the remaining 53) were discharged the same day without ultrasound control. The remaining 18 stayed overnight for reasons not related to the access site (hemodynamic surveillance, initiation of antiarrhythmic drugs or loss of phrenic capture), allowing in any case early mobilization (three hours after the procedure). Mean follow-up was 272 ± 160 days, with no adverse events recorded. Conclusion: SVD are safe and effective in achieving rapid hemostasis, making the early mobilization and same-day discharge protocol after AF ablation feasible in selected patients. Age 63 (57-71) Male 46 (73%) Body mass index (kg/m²) 27,5 (24,2-31,6) Previous anticoagulation- Vitamin K antagonist- Direct oral anticoagulation 50 (79,4%)14 (28%)36 (72%)

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The Role of Atrial Fibrosis Detected by Delayed - Enhancement MRI in Atrial Fibrillation Ablation

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405614666180806130327 ◽

2020 ◽

Vol 16 (2) ◽

pp. 135-144 ◽

Cited By ~ 1

Author(s):

Zsuzsanna Kis ◽

Astrid Amanda Hendriks ◽

Taulant Muka ◽

Wichor M. Bramer ◽

Istvan Kovacs ◽

...

Keyword(s):

Atrial Fibrillation ◽

Imaging Modality ◽

Final Analysis ◽

Atrial Fibrosis ◽

Atrial Wall ◽

Af Ablation ◽

Left Atrial Wall ◽

Cmr Imaging

Introduction: Atrial Fibrillation (AF) is associated with remodeling of the atrial tissue, which leads to fibrosis that can contribute to the initiation and maintenance of AF. Delayed- Enhanced Cardiac Magnetic Resonance (DE-CMR) imaging for atrial wall fibrosis detection was used in several studies to guide AF ablation. The aim of present study was to systematically review the literature on the role of atrial fibrosis detected by DE-CMR imaging on AF ablation outcome. Methods: Eight bibliographic electronic databases were searched to identify all published relevant studies until 21st of March, 2016. Search of the scientific literature was performed for studies describing DE-CMR imaging on atrial fibrosis in AF patients underwent Pulmonary Vein Isolation (PVI). Results: Of the 763 citations reviewed for eligibility, 5 articles (enrolling a total of 1040 patients) were included into the final analysis. The overall recurrence of AF ranged from 24.4 - 40.9% with median follow-up of 324 to 540 days after PVI. With less than 5-10% fibrosis in the atrial wall there was a maximum of 10% recurrence of AF after ablation. With more than 35% fibrosis in the atrial wall there was 86% recurrence of AF after ablation. Conclusion: Our analysis suggests that more extensive left atrial wall fibrosis prior ablation predicts the higher arrhythmia recurrence rate after PVI. The DE-CMR imaging modality seems to be a useful method for identifying the ideal candidate for catheter ablation. Our findings encourage wider usage of DE-CMR in distinct AF patients in a pre-ablation setting.

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Posterior circulation stroke: an easily overlooked complication of catheter ablation of atrial fibrillation

BMJ Case Reports ◽

10.1136/bcr-2020-234661 ◽

2020 ◽

Vol 13 (8) ◽

pp. e234661

Author(s):

Tahir Nazir ◽

Mohiuddin Sharief ◽

James Farthing ◽

Irfan M Ahmed

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Treatment Options ◽

Posterior Circulation ◽

Diagnosis And Treatment ◽

Neurological Deficits ◽

Cerebellar Infarction ◽

Af Ablation ◽

Posterior Circulation Stroke ◽

Ventricular Response

Catheter ablation of atrial fibrillation (AF) has established itself as a safe and proven rhythm control strategy for selected patients with AF over the past decade. Thromboembolic complications of catheter ablation are becoming rare in anticoagulated patients with a risk of stroke reported as 0.3%. A particular challenge is posed by clinical presentation due to ischaemic stroke involving the posterior circulation following catheter ablation because of its substantial differences from the carotid territory stroke, making the timely diagnosis and treatment very difficult. It is crucial to keep an index of clinical suspicion in patients presenting with neurological deficits related to vertebrobasilar circulation following ablation. We describe the case of a man who presented with dizziness and palpitations after radiofrequency catheter ablation of AF. He was found to be in AF with a rapid ventricular response. His dizziness was initially attributed to the cardiac dysrhythmia. As his symptoms continued despite heart rate control, he underwent further investigations and was eventually diagnosed with a posterior circulation stroke resulting in left cerebellar infarction. He was treated with antiplatelet therapy and improved significantly over the following few days. We review and present an up-to-date brief literature review on the complications of catheter ablation of AF and describe pathophysiology, clinical features, diagnosis and treatment options for posterior circulation stroke after AF ablation. This case aims to raise awareness among clinicians about posterior circulation stroke after AF ablation.

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