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Rajendra A, Hunter TD, Morales G, Osorio J. Prospective implementation of a same-day discharge protocol for catheter ablation of paroxysmal atrial fibrillation. J Interv Card Electrophysiol 2020; 62:419-425. [PMID: 33219896 PMCID: PMC7679791 DOI: 10.1007/s10840-020-00914-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/08/2020] [Indexed: 11/25/2022]
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 post-procedure 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.
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Affiliation(s)
- Anil Rajendra
- Arrhythmia Institute at Grandview, Grandview Medical Center, 3686 Grandview Parkway, Suite 720, Birmingham, AL, 35243, USA.
| | - Tina D Hunter
- Real World Evidence, CTI Clinical Trial & Consulting Services, 100 E Rivercenter Blvd, Covington, KY, 41011, USA
| | - Gustavo Morales
- Arrhythmia Institute at Grandview, Grandview Medical Center, 3686 Grandview Parkway, Suite 720, Birmingham, AL, 35243, USA
| | - Jose Osorio
- Arrhythmia Institute at Grandview, Grandview Medical Center, 3686 Grandview Parkway, Suite 720, Birmingham, AL, 35243, USA
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Creta A, Ventrella N, Providência R, Earley MJ, Sporton S, Dhillon G, Papageorgiou N, Chow A, Lambiase PD, Lowe M, Schilling RJ, Finlay M, Hunter RJ. Same‐day discharge following catheter ablation of atrial fibrillation: A safe and cost‐effective approach. J Cardiovasc Electrophysiol 2020; 31:3097-3103. [DOI: 10.1111/jce.14789] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/03/2020] [Accepted: 10/07/2020] [Indexed: 01/01/2023]
Affiliation(s)
- Antonio Creta
- Department of Electrophysiology, Barts Heart Center St. Bartholomew's Hospital London UK
| | - Nicoletta Ventrella
- Faculty of Medicine and Surgery Campus Bio‐Medico University of Rome Rome Italy
| | - Rui Providência
- Department of Electrophysiology, Barts Heart Center St. Bartholomew's Hospital London UK
| | - Mark J. Earley
- Department of Electrophysiology, Barts Heart Center St. Bartholomew's Hospital London UK
| | - Simon Sporton
- Department of Electrophysiology, Barts Heart Center St. Bartholomew's Hospital London UK
| | - Gurpreet Dhillon
- Department of Electrophysiology, Barts Heart Center St. Bartholomew's Hospital London UK
| | - Nikolaos Papageorgiou
- Department of Electrophysiology, Barts Heart Center St. Bartholomew's Hospital London UK
| | - Anthony Chow
- Department of Electrophysiology, Barts Heart Center St. Bartholomew's Hospital London UK
| | - Pier D. Lambiase
- Department of Electrophysiology, Barts Heart Center St. Bartholomew's Hospital London UK
| | - Martin Lowe
- Department of Electrophysiology, Barts Heart Center St. Bartholomew's Hospital London UK
| | - Richard J. Schilling
- Department of Electrophysiology, Barts Heart Center St. Bartholomew's Hospital London UK
| | - Malcolm Finlay
- Department of Electrophysiology, Barts Heart Center St. Bartholomew's Hospital London UK
| | - Ross J. Hunter
- Department of Electrophysiology, Barts Heart Center St. Bartholomew's Hospital London UK
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He H, Datla S, Weight N, Raza S, Lachlan T, Aldhoon B, Panikker S, Dhanjal T, Yusuf S, Foster W, Hayat S, Osman F. Safety and cost-effectiveness of same-day complex left atrial ablation. Int J Cardiol 2020; 322:170-174. [PMID: 33002522 PMCID: PMC7521347 DOI: 10.1016/j.ijcard.2020.09.066] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/18/2020] [Accepted: 09/23/2020] [Indexed: 11/28/2022]
Abstract
Background Catheter ablation for complex left-atrial arrhythmia is increasing worldwide with many centres admitting patients overnight. Same-day procedures using conscious sedation carry significant benefits to patients/healthcare providers but data are limited. We evaluated the safety and cost-effectiveness of same-day complex left-atrial arrhythmia ablation. Method Multi-centre retrospective cohort study of all consecutive complex elective left-atrial ablation procedures performed between January 2011 and December 2019. Data were collected on planned same-day discharge versus overnight stay, baseline parameters, procedure details/success, ablation technology, post-operative complications, unplanned overnight admissions/outcomes at 4-months and mortality up to April 2020. A cost analysis of potential savings was also performed. Results A total of 967 consecutive patients underwent complex left-ablation using radiofrequency (point-by-point ablation aided by 3D-mapping or PVAC catheter ablation with fluoroscopic screening) or cryoballoon-ablation (mean age: 60.9 ± 11.6 years, range 23-83 yrs., 572 [59%] females). The majority of patients had isolation of pulmonary veins alone (n = 846, 87%) and most using conscious-sedation alone (n = 921, 95%). Of the total cohort, 414 (43%) had planned same-day procedure with 35 (8%) admitted overnight due to major (n = 5) or minor (n = 30) complications. Overall acute procedural success-rate was 96% (n = 932). Complications in planned overnight-stay/same-day cohorts were low. At 4-month follow-up there were 62 (6.4%) readmissions (femoral haematomas, palpitation, other reasons); there were 3 deaths at mean follow-up of 42.0 ± 27.6 months, none related to the procedure. Overnight stay costs £350; the same-day ablation policy over this period would have saved £310,450. Conclusions Same-day complex left-atrial catheter ablation using conscious sedation is safe and cost-effective with significant benefits for patients and healthcare providers. This is especially important in the current financial climate and Covid-19 pandemic. We have previously reported same-day standard catheter ablation is safe, feasible and cost-effective. Data on same-day complex left-atrial ablation are limited. Our multi-centre cohort study of 967 consecutive elective complex left-atrial ablation procedures between January 2011 and December 2019 revealed same-day ablations using conscious sedation were safe and associated with very few complications and could have significant benefits to patients and cost-savings for healthcare providers worldwide. Same-day complex left-atrial ablation procedures can be performed safely without the need for overnight-stay. This has major implications for both patients and healthcare providers, especially given the current financial challenges and Covid-19 pandemic.
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Affiliation(s)
- Hejie He
- Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK; Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry CV4 7HL, UK
| | - Sushma Datla
- Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - Nicholas Weight
- Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - Sidra Raza
- Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - Thomas Lachlan
- Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK; Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry CV4 7HL, UK
| | - Bashar Aldhoon
- Department of Cardiology, Worcester Royal Hospital, Charles Hastings Way, Worcester WR5 1DD, UK
| | - Sandeep Panikker
- Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - Tarv Dhanjal
- Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK; Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry CV4 7HL, UK
| | - Shamil Yusuf
- Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - William Foster
- Department of Cardiology, Worcester Royal Hospital, Charles Hastings Way, Worcester WR5 1DD, UK
| | - Sajad Hayat
- Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK; Department of Adult Cardiology Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Faizel Osman
- Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK; Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry CV4 7HL, UK.
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