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Aguilera J, Hutt E, Madden R, Kanj M, Saliba W, Rickard J, Sroubek J, Callahan T, Chung M, Baranowski B, Martin D, Dresing T, Wazni OM, Hussein A, Cantillon D, Patel D, Nakhla S, Taigen T. Same-day discharge after atrial fibrillation ablation. Heliyon 2023; 9:e22178. [PMID: 38045193 PMCID: PMC10692798 DOI: 10.1016/j.heliyon.2023.e22178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 10/20/2023] [Accepted: 11/06/2023] [Indexed: 12/05/2023] Open
Abstract
Background Atrial fibrillation (AF) catheter ablation has become an increasingly effective and safe strategy for the management of AF. With increased safety of catheter ablation, same-day discharge (SDD) is a potential way to minimize health care resource utilization and improve patient experience. Objective To evaluate the safety and patient satisfaction of SDD after contemporary AF ablation. Methods Consecutive patient undergoing AF ablation at our institution between 1/2020 and 10/2021 were enrolled in registry for clinical, quality, procedural and outcomes data. Patients were considered for SDD per physician discretion and patients' preference based upon clinical evaluation. Adjudicated ninety-day major complications, thirty-day adverse events, and thirty-day re-admissions were collected in a prospective registry for all patients. Results A total of 2142 consecutive patients underwent elective AF ablation during the study period. After excluding cases with missing data, 1830 patients were included in the analysis. Of those, 350 (19 %) patients were discharged the same day (SDD group) and 1480 (81 %) stayed overnight. Patients in the SDD group compared to overnight stay group were younger, more likely to be male, White patients, lower CHA2DS2-VASc score and to be on lower rates of warfarin as an anticoagulation strategy. After propensity score matching, SDD was associated with lower rate of major complications and higher patient satisfaction. The majority of life-treating complications occurred interprocedurally or within 6 h of procedure termination. Conclusion The present study demonstrated that SDD after contemporary AF ablation is feasible, safe and associated with higher patient satisfaction using a proposed SDD pathway and criteria.
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Affiliation(s)
- Jose Aguilera
- Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH, USA
| | - Erika Hutt
- Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH, USA
| | - Ruth Madden
- Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH, USA
| | - Mohamed Kanj
- Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH, USA
| | - Walid Saliba
- Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH, USA
| | - John Rickard
- Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH, USA
| | - Jakub Sroubek
- Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH, USA
| | - Thomas Callahan
- Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH, USA
| | - Mina Chung
- Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH, USA
| | - Brian Baranowski
- Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH, USA
| | - David Martin
- Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH, USA
| | - Thomas Dresing
- Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH, USA
| | - Oussama M. Wazni
- Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH, USA
| | - Ayman Hussein
- Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH, USA
| | - Daniel Cantillon
- Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH, USA
| | - Divyang Patel
- Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH, USA
| | - Shady Nakhla
- Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH, USA
| | - Tyler Taigen
- Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH, USA
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Kisling AJ, Symons JG, Daubert JP. Catheter ablation of atrial fibrillation: anticipating and avoiding complications. Expert Rev Med Devices 2023; 20:929-941. [PMID: 37691572 DOI: 10.1080/17434440.2023.2257131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/06/2023] [Indexed: 09/12/2023]
Abstract
INTRODUCTION Atrial fibrillation (AF) ablation is being performed more frequently and more widely at more centers. This stems from several factors including 1) demographic forces leading to an increased prevalence of the arrhythmia; 2) greater availability of ambulatory monitoring making diagnosis more frequent; 3) relative inefficacy of medications; and 4) improved safety and efficacy of the procedure. Ablation has become much more streamlined and reproducible than a decade ago, but life-threatening complications may still arise. AREAS COVERED This review will focus on awareness, avoidance, and early recognition and management of complications of AF ablation. This literature review is challenged by differing approaches to ablation of AF both within a center and between centers, the rapid improvement of technology making the outcomes associated with a therapeutic strategy begun a few years prior relatively obsolete, as well as the heterogeneity of the population being studied. EXPERT OPINION Newer technologies are on the horizon which will allow us to ablate AF with increasing efficacy, efficiency, and hopefully safety. Such new technology and changing usage mandate vigilance to avoid complications.
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Affiliation(s)
- Adam J Kisling
- Walter Reed National Military Medical Center, Department of Cardiology, Bethesda, MD, United States of America
| | - John G Symons
- Walter Reed National Military Medical Center, Department of Electrophysiology, Bethesda, MD, United States of America
| | - James P Daubert
- Electrophysiology Section/Duke Center for Atrial Fibrillation, Division of Cardiology, Duke Clinical Research Institute, Department of Medicine, Duke University, Durham, NC, United States of America
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Tang PT, Davies M, Bashir Y, Betts TR, Pedersen M, Rajappan K, Ginks MR, Wijesurendra RS. Efficacy and safety of same-day discharge after atrial fibrillation ablation compared with post-procedural overnight stay: a systematic review and meta-analysis. Europace 2022; 24:1569-1584. [PMID: 35640891 DOI: 10.1093/europace/euac068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/10/2022] [Indexed: 11/14/2022] Open
Abstract
AIMS Catheter ablation for atrial fibrillation (AF) has historically required inpatient admission post-procedure, but same-day discharge (SDD) has recently been reported. We aimed to assess the efficacy and safety of SDD compared with overnight stay (OS) post-ablation. METHODS AND RESULTS We performed a systematic search of the PubMed database. Random-effects meta-analysis was performed to assess the efficacy (successful SDD) and safety (24 h complications, 30-day complications, 30-day re-admissions, and 30-day mortality) of a SDD AF ablation strategy. Fourteen non-randomized observational studies met criteria for inclusion, encompassing 26488 patients undergoing AF ablation, of whom 9766 were SDD. The mean age of participants was 61.9 years, and 67.9% were male. Around 61.7% underwent ablation for paroxysmal AF. The pooled success rate of SDD was 83.2% [95% confidence intervals (CIs): 61.5-97.0%, I2 100%]. The risk of bias was severe for all effect estimates due to confounding, as most cohorts were retrospectively identified without appropriately matched comparators. There was no significant difference in 30-day complications [odds ratio (OR): 0.95, 95% CI: 0.65-1.40, I2 53%] or 30-day re-admission (OR 0.96, 95% CI: 0.49-1.89, I2 82%) between groups. There were insufficient data for meta-analysis of 24 h complications and 30-day mortality. Where reported, no re-admissions occurred due to 24 h complications after SDD. Two deaths (0.04%) were reported in both SDD and OS groups. CONCLUSION Same-day discharge after AF ablation appears to be an effective and safe strategy in selected patients. However, the available evidence is of low quality, and more robust prospective studies comparing SDD to OS are needed.
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Affiliation(s)
- Pok-Tin Tang
- Royal Berkshire Hospital, Royal Berkshire Hospitals NHS Foundation Trust, RG1 5AN Reading, UK
| | - Mark Davies
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, OX3 9DU Oxford, UK
| | - Yaver Bashir
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, OX3 9DU Oxford, UK
| | - Timothy R Betts
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, OX3 9DU Oxford, UK.,Oxford Biomedical Research Centre, Oxford University Hospitals, OX3 9DU Oxford, UK.,Division of Cardiovascular Medicine, Radcliffe Department of Medicine, OX3 9DU University of Oxford, UK
| | - Michala Pedersen
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, OX3 9DU Oxford, UK
| | - Kim Rajappan
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, OX3 9DU Oxford, UK
| | - Matthew R Ginks
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, OX3 9DU Oxford, UK
| | - Rohan S Wijesurendra
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, OX3 9DU Oxford, UK.,Oxford Biomedical Research Centre, Oxford University Hospitals, OX3 9DU Oxford, UK.,Division of Cardiovascular Medicine, Radcliffe Department of Medicine, OX3 9DU University of Oxford, UK
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Innovations in atrial fibrillation ablation. J Interv Card Electrophysiol 2022; 66:737-756. [PMID: 35411440 DOI: 10.1007/s10840-022-01215-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/05/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Catheter-based ablation to perform pulmonary vein isolation (PVI) has established itself as a mainstay in the rhythm control strategy of atrial fibrillation. This review article aims to provide an overview of recent advances in atrial fibrillation ablation technology. METHODS We reviewed the available literature and clinical trials of innovations in atrial fibrillation ablation technologies including ablation catheter designs, alternative energy sources, esophageal protection methods, electroanatomical mapping, and novel ablation targets. RESULTS Innovative radiofrequency (RF) catheter designs maximize energy delivery while avoiding overheating associated with conventional catheters. Single-shot balloon catheters in the form of cryoballoons, radiofrequency, and laser balloons have proven effective at producing pulmonary vein isolation and improving procedural efficiency and reproducibility. Pulsed field ablation (PFA) is a highly anticipated novel nonthermal energy source under development, which demonstrates selective ablation of the myocardium, producing durable lesions while also minimizing collateral damage. Innovative devices for esophageal protection including esophageal deviation and cooling devices have been developed to reduce esophageal complications. Improved electroanatomical mapping systems are being developed to help identify additional non-pulmonary triggers, which may benefit from ablation, especially with persistent atrial fibrillation. Lastly, the vein of Marshall alcohol ablation has been recently studied as an adjunct therapy for improving outcomes with catheter ablation for persistent atrial fibrillation. CONCLUSIONS Numerous advances have been made in the field of atrial fibrillation ablation in the past decade. While further long-term data is still needed for these novel technologies, they show potential to improve procedural efficacy and safety.
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