Prospective implementation of a same-day discharge protocol for catheter ablation of paroxysmal atrial fibrillation
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Prospective implementation of a same-day discharge protocol for catheter ablation of paroxysmal atrial fibrillation Anil Rajendra 1
&
Tina D. Hunter 2 & Gustavo Morales 1 & Jose Osorio 1
Received: 12 August 2020 / Accepted: 8 November 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
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 CHA2DS2-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. Keywords Atrialfibrillation . Catheter ablation . Same-daydischarge . Same-day discharge protocol . Low-riskpatients . Daycase ablation
1 Introduction Catheter ablation for atrial fibrillation (AF) has become one of the most commonly performed electrophysiologic procedures, and it accounts for a significant proportion of the overall cost for the treatment of AF [1]. In recent years, a notable decrease in complication rates for AF ablation cases have been observed [2], leading to an increasing proportion of the procedures performed in an outpatient setting, commonly with overnight monitoring for complications [3]. Ignacio et al. observed that most ablation-related complications were detected * Anil Rajendra [email protected] 1
Arrhythmia Institute at Grandview, Grandview Medical Center, 3686 Grandview Parkway, Suite 720, Birmingham, AL 35243, USA
2
Real World Evidence, CTI Clinical Trial & Consulting Services, 100 E Rivercenter Blvd, Covington, KY 41011, USA
during or shortly after the ablation procedure, with on
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