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Sgarito G, Cascino A, Ferrara G, Conti S. Micro-Costing Analysis for the Treatment of Atrial Fibrillation: An Economic Evaluation of the First Italian Experience of Same-Day Discharge Protocol for Cryoballoon Atrial Fibrillation Ablation. J Clin Med 2024; 13:2836. [PMID: 38792377 PMCID: PMC11122004 DOI: 10.3390/jcm13102836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 04/27/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia, and its prevalence is expected to increase further due to the aging population, increasing prevalence of risk factors, improving detection methods, and broadening of catheter ablation indications. Along with limited healthcare resources and bed availability, these reasons led to the development of a same-day discharge (SDD) protocol. The aim of this study was to evaluate the health and economic impact of a routine adoption of same-day discharge after cryoballoon AF ablation. Methods: Consecutive patients with symptomatic and drug-refractory AF scheduled for first-time AF ablation were screened, and if deemed suitable, the SDD protocol was proposed and, if accepted, enrolled in the protocol. Results: A total of 324 patients were screened, and 118 were considered eligible for the SDD pathway. Fifty-two patients accepted the SDD pathway and were included in this study. The analysis showed that the variation in resource consumption associated with cryoablation in SDD is equal to EUR 739.85/patient. The analysis showed that the main cost driver for ordinary hospitalization was represented by the hospital stay, which was calculated to be 36% of the total cost. In total, there was a cost reduction of EUR 38.472 thanks to optimized AF patient management from the standard recovery setting to SDD. Conclusions: SDD after cryoballoon ablation of AF is feasible in selected patients with a standardized protocol.
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Affiliation(s)
| | | | | | - Sergio Conti
- Department of Electrophysiology, ARNAS Civico-Di Cristina-Benfratelli, 90127 Palermo, Italy; (G.S.); (A.C.); (G.F.)
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2
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Palmieri V, Yijin X, Fischbach P, Whitehill R. Safety of same-day discharge without anticoagulation for left-sided radiofrequency catheter ablations in pediatrics. Heart Rhythm 2024; 21:592-599. [PMID: 38215810 DOI: 10.1016/j.hrthm.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 12/19/2023] [Accepted: 01/04/2024] [Indexed: 01/14/2024]
Abstract
BACKGROUND For left-sided radiofrequency catheter ablation (LCA) in pediatrics, significant practice variability exists regarding anticoagulation and discharge practices. Given the lack of data in pediatric patients, the risks and benefits of these practices are not well defined. OBJECTIVE The purpose of this study was to evaluate the safety of same-day discharge and use of aspirin (ASA) in pediatric patients following LCA. METHODS We performed a retrospective cohort study of pediatric patients who underwent LCA from 2010 to 2020 at our institution. Discharge timing and ASA usage were based on operator preference. The primary outcome was incidence of postablation anticoagulation complications reported within 1 month of the procedure. RESULTS Three hundred seventy-six patients underwent LCA and met inclusion criteria. Median [25th, 75th percentiles] age was 13.9 [10.5, 16.2] years; 18 (4.7%) had a history of structural heart disease. The most common substrates for ablation were Wolff-Parkinson-White syndrome (183 patients [48.7%]), concealed accessory pathway (159 patients [42.3%]), and ectopic atrial tachycardia (10 patients [2.7%]). Three hundred thirty-eight patients (89.9%) were discharged on the day of LCA. Seventy-six patients (20.2%) were prescribed ASA at discharge. Of those who underwent follow-up (273 patients [72.6%]), 7 (2.7%) reported an anticoagulation complication (5 with hematoma, 2 with headache). One of these patients was prescribed ASA; none required readmission. There was no correlation between anticoagulation complications and same-day discharge or with ASA usage. CONCLUSION Given the rare incidence of anticoagulation complications in pediatric patients undergoing LCAs, same-day discharge from the electrophysiology laboratory without anticoagulation should be considered.
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Affiliation(s)
- Vincent Palmieri
- Children's Healthcare of Atlanta Cardiology, Atlanta, Georgia; Emory University School of Medicine, Atlanta, Georgia.
| | - Xiang Yijin
- Emory University School of Medicine, Atlanta, Georgia
| | - Peter Fischbach
- Children's Healthcare of Atlanta Cardiology, Atlanta, Georgia; Emory University School of Medicine, Atlanta, Georgia
| | - Robert Whitehill
- Children's Healthcare of Atlanta Cardiology, Atlanta, Georgia; Emory University School of Medicine, Atlanta, Georgia
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3
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Gee Lim V, He H, Lachlan T, Ammar A, Foster W, Panikker S, Dhanjal T, Yusuf S, Patel K, Osman F. Use of Satellite-Sites for Percutaneous Cardiac Ablations (the Hub-and-Spoke Model): Lessons From the COVID-19 Pandemic. Circ Cardiovasc Qual Outcomes 2023; 16:e010126. [PMID: 37855158 DOI: 10.1161/circoutcomes.123.010126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Affiliation(s)
- Ven Gee Lim
- Institute of Cardio-Metabolic Medicine Research Institute, University Hospitals Coventry and Warwickshire NHS Trust, United Kingdom (V.G.L., H.H., T.L., S.P., T.D., S.Y., K.P., F.O.)
- Division of Medical Sciences, Warwick Medical School, University of Warwick (V.G.L., H.H., T.L., S.P., T.D., K.P., F.O.)
| | - Hejie He
- Institute of Cardio-Metabolic Medicine Research Institute, University Hospitals Coventry and Warwickshire NHS Trust, United Kingdom (V.G.L., H.H., T.L., S.P., T.D., S.Y., K.P., F.O.)
- Division of Medical Sciences, Warwick Medical School, University of Warwick (V.G.L., H.H., T.L., S.P., T.D., K.P., F.O.)
| | - Thomas Lachlan
- Institute of Cardio-Metabolic Medicine Research Institute, University Hospitals Coventry and Warwickshire NHS Trust, United Kingdom (V.G.L., H.H., T.L., S.P., T.D., S.Y., K.P., F.O.)
- Division of Medical Sciences, Warwick Medical School, University of Warwick (V.G.L., H.H., T.L., S.P., T.D., K.P., F.O.)
| | - Ahmed Ammar
- Department of Cardiology, Worcester Royal Hospital, Charles Hastings Way, Worcester, United Kingdom (A.A., W.F.)
| | - William Foster
- Department of Cardiology, Worcester Royal Hospital, Charles Hastings Way, Worcester, United Kingdom (A.A., W.F.)
| | - Sandeep Panikker
- Institute of Cardio-Metabolic Medicine Research Institute, University Hospitals Coventry and Warwickshire NHS Trust, United Kingdom (V.G.L., H.H., T.L., S.P., T.D., S.Y., K.P., F.O.)
- Division of Medical Sciences, Warwick Medical School, University of Warwick (V.G.L., H.H., T.L., S.P., T.D., K.P., F.O.)
| | - Tarv Dhanjal
- Institute of Cardio-Metabolic Medicine Research Institute, University Hospitals Coventry and Warwickshire NHS Trust, United Kingdom (V.G.L., H.H., T.L., S.P., T.D., S.Y., K.P., F.O.)
- Division of Medical Sciences, Warwick Medical School, University of Warwick (V.G.L., H.H., T.L., S.P., T.D., K.P., F.O.)
| | - Shamil Yusuf
- Institute of Cardio-Metabolic Medicine Research Institute, University Hospitals Coventry and Warwickshire NHS Trust, United Kingdom (V.G.L., H.H., T.L., S.P., T.D., S.Y., K.P., F.O.)
| | - Kiran Patel
- Institute of Cardio-Metabolic Medicine Research Institute, University Hospitals Coventry and Warwickshire NHS Trust, United Kingdom (V.G.L., H.H., T.L., S.P., T.D., S.Y., K.P., F.O.)
- Division of Medical Sciences, Warwick Medical School, University of Warwick (V.G.L., H.H., T.L., S.P., T.D., K.P., F.O.)
| | - Faizel Osman
- Institute of Cardio-Metabolic Medicine Research Institute, University Hospitals Coventry and Warwickshire NHS Trust, United Kingdom (V.G.L., H.H., T.L., S.P., T.D., S.Y., K.P., F.O.)
- Division of Medical Sciences, Warwick Medical School, University of Warwick (V.G.L., H.H., T.L., S.P., T.D., K.P., F.O.)
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4
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König S, Wohlrab L, Leiner J, Pellissier V, Nitsche A, Darma A, Hilbert S, Nedios S, Seewöster T, Dinov B, Hindricks G, Bollmann A. Patient perspectives on same-day discharge following catheter ablation for atrial fibrillation: results from a patient survey as part of the monocentric FAST AFA trial. Europace 2023; 25:euad262. [PMID: 37656979 PMCID: PMC10492224 DOI: 10.1093/europace/euad262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 08/11/2023] [Indexed: 09/03/2023] Open
Abstract
AIMS Same-day discharge (SDD) following catheter ablation (CA) of atrial fibrillation (AF) was already introduced in selected facilities in Europe, but a widespread implementation has not yet succeeded. Data on patients' perspectives are lacking. Therefore, we conducted a survey to address patients' beliefs towards SDD and identify variables that are associated with their evaluation. METHODS AND RESULTS As part of the prospective, monocentric FAST AFA trial, patients aged ≥20 years undergoing left atrial CA for AF were asked to participate in the survey consisting of a study-specific questionnaire, the AF knowledge scale, and pre-defined patient-reported outcome measures. The study cohort was stratified based on SDD willingness, and a logistic regression analysis was used to identify predictors for patients' valuation. Between 26 July 2021 and 01 July 2022, 256 of 376 screened patients consented to study participation of whom 248 (mean age 61.8 years, 33.9% female) completed the SDD survey. Of them, 50.0% were willing to have SDD concepts integrated into their clinical course with increased patient comfort (27.5%), shorter waiting times (14.6%), and a cost-efficient treatment (14.0%) being imaginable benefits. In contrast, expressed concerns included uncertainties with occurring complaints (50.6%), the insufficient recognition (47.8%), and treatment (48.9%) of complications. European Heart Rhythm Association class at baseline and inpatient treatments within the preceding year were predictors for SDD willingness whereas comorbidity burden or AF knowledge were not. CONCLUSION We provide a detailed survey expressing patients' beliefs towards SDD following left atrial CA. Our findings may facilitate adequate patient selection to improve the future implementation of SDD programs in suitable cohorts.
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Affiliation(s)
- Sebastian König
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany
- Real World Evidence & Health Technology Assessment, Helios Health Institute, Berlin, Germany
| | - Lisa Wohlrab
- Real World Evidence & Health Technology Assessment, Helios Health Institute, Berlin, Germany
| | - Johannes Leiner
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany
- Real World Evidence & Health Technology Assessment, Helios Health Institute, Berlin, Germany
| | - Vincent Pellissier
- Real World Evidence & Health Technology Assessment, Helios Health Institute, Berlin, Germany
| | - Anne Nitsche
- Real World Evidence & Health Technology Assessment, Helios Health Institute, Berlin, Germany
| | - Angeliki Darma
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany
| | - Sebastian Hilbert
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany
| | - Sotirios Nedios
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany
| | - Timm Seewöster
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany
| | - Borislav Dinov
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany
- Real World Evidence & Health Technology Assessment, Helios Health Institute, Berlin, Germany
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5
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Khan JA, Parmar M, Bhamare A, Agarwal S, Khosla J, Liu B, Abraham R, Khan T, Clifton S, Munir MB, DeSimone CV, Deshmukh A, Po S, Stavrakis S, Asad ZUA. Same-day discharge for left atrial appendage occlusion procedure: A systematic review and meta-analysis. J Cardiovasc Electrophysiol 2023; 34:1196-1205. [PMID: 37130436 DOI: 10.1111/jce.15914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/02/2023] [Accepted: 04/13/2023] [Indexed: 05/04/2023]
Abstract
INTRODUCTION Most patients undergoing a left atrial appendage occlusion (LAAO) procedure are admitted for overnight observation. A same-day discharge strategy offers the opportunity to improve resource utilization without compromising patient safety. We compared the patient safety outcomes and post-discharge complications between same-day discharge versus hospital admission (HA) (>1 day) in patients undergoing LAAO procedure. METHODS A systematic search of MEDLINE and Embase was conducted. Outcomes of interest included peri-procedural complications, re-admissions, discharge complications including major bleeding and vascular complications, ischemic stroke, all-cause mortality, and peri-device leak >5 mm. Mantel-Haenszel risk ratios (RRs) with 95% CIs were calculated. RESULTS A total of seven observational studies met the inclusion criteria. There was no statistically significant difference between same-day discharge versus HA regarding readmission (RR: 0.61; 95% confidence interval [CI]: [0.29-1.31]; p = .21), ischemic stroke after discharge (RR: 1.16; 95% CI: [0.49-2.73]), peri-device leak >5 mm (RR: 1.27; 95% CI: [0.42-3.85], and all-cause mortality (RR: 0.60; 95% CI: [0.36-1.02]). The same-day discharge study group had significantly lower major bleeding or vascular complications (RR: 0.71; 95% CI: [0.54-0.94]). CONCLUSIONS This meta-analysis of seven observational studies showed no significant difference in patient safety outcomes and post-discharge complications between same-day discharge versus HA. These findings provide a solid basis to perform a randomized control trial to eliminate any potential confounders.
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Affiliation(s)
- Jehanzeb Ahmed Khan
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Miloni Parmar
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Aditi Bhamare
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Siddharth Agarwal
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Jagjit Khosla
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Briana Liu
- College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Rachel Abraham
- College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Taha Khan
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Shari Clifton
- Robert M Bird Health Sciences Library, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Muhammad Bilal Munir
- Section of Electrophysiology, Division of Cardiology, University of California Davis, Davis, California, USA
| | | | - Abhishek Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sunny Po
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Stavros Stavrakis
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Zain Ul Abideen Asad
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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6
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Safety and feasibility of same-day discharge for catheter ablation of atrial fibrillation: a systematic review and meta-analysis. J Interv Card Electrophysiol 2022; 65:803-811. [PMID: 35147827 DOI: 10.1007/s10840-022-01145-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 01/31/2022] [Indexed: 12/16/2022]
Abstract
PURPOSE Most centers performing catheter ablation (CA) of atrial fibrillation (AF) admit the patients for an overnight hospital stay to monitor for post-procedure complications, but the clinical benefits of this overnight hospital admission policy have not been carefully investigated. We hypothesized that same-day discharge strategy is safe and feasible in patients with AF undergoing CA. METHODS A systematic review of studies comparing the safety of same-day discharge vs hospital admission for AF patients undergoing CA was conducted in PubMed/MEDLINE, Embase, Scopus, and Web of Science. No randomized controlled trials met the inclusion criteria; therefore, observational cohort studies were included. Mantel-Haenszel risk ratios were calculated and I2 statistics were reported for heterogeneity assessment. RESULTS A total of 8 observational studies with 10,102 patients were included. There were no statistically significant differences between same-day discharge vs hospital admission in all studied outcomes including post-discharge 30-day hospital visits (RR: 0.90; 95% CI: 0.40-2.02; p = 0.81), post-discharge vascular/bleeding complications (RR: 0.93; 95% CI: 0.46-1.88; p = 0.85), post-discharge stroke/transient ischemic attack/thromboembolism (RR: 0.70; 95% CI: 0.23-2.20; p = 0.55), and post-discharge recurrent arrhythmias (RR: 0.81; 95% CI: 0.60-1.09; p = 0.1). CONCLUSION In carefully selected AF patients undergoing CA, same-day discharge strategy is feasible and safe. There are no significant differences in post-discharge 30-day hospital visits, post-discharge vascular complications, and other safety outcomes. Randomized trials are needed to validate these hypothesis-generating findings.
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7
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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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8
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König S, Richter S, Bollmann A, Hindricks G. Safety and feasibility of same-day discharge following catheter ablation of atrial fibrillation: what is known and what needs to be explored? Herz 2022; 47:123-128. [PMID: 35257191 DOI: 10.1007/s00059-022-05102-0] [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] [Accepted: 02/02/2022] [Indexed: 11/25/2022]
Abstract
Catheter ablation of atrial fibrillation (AF) is the most effective rhythm control strategy and its role in the treatment of AF patients has been strengthened by recent guidelines. An increasing AF prevalence and the resulting demands on interventional electrophysiology call for improved resource allocation through both technical innovations and streamlined workflows and patient pathways. Same-day discharge is already established in the context of other electrophysiological interventions; however, its broad implementation in the practice of AF ablation is pending for several reasons, despite the fact that the body of evidence is growing and the majority of reports propagate early discharge to be feasible and safe under certain conditions. This review article is intended to provide an overview of the existing data, classify these into the specific study context, and to show limitations and open questions.
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Affiliation(s)
- Sebastian König
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany.
- Leipzig Heart Institute, Leipzig, Germany.
| | - Sergio Richter
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany
- Leipzig Heart Institute, Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany
- Leipzig Heart Institute, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany
- Leipzig Heart Institute, Leipzig, Germany
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Rashedi S, Tavolinejad H, Kazemian S, Mardani M, Masoudi M, Masoudkabir F, Haghjoo M. Efficacy and safety of same-day discharge after atrial fibrillation ablation: A systematic review and meta-analysis. Clin Cardiol 2022; 45:162-172. [PMID: 35084049 PMCID: PMC8860483 DOI: 10.1002/clc.23778] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/29/2021] [Accepted: 01/04/2022] [Indexed: 12/17/2022] Open
Abstract
Conventionally, patients have been admitted overnight after atrial fibrillation (AF) catheter ablation. Several centers have recently adopted a same‐day discharge (SDD) protocol for patients undergoing AF catheter ablation. We aimed to systematically review the current evidence for the safety and efficacy of SDD after AF catheter ablation. A systematic search was performed in PubMed, Embase, Scopus, Web of Science, and the Cochrane library until August 21, 2021. The risk of bias was assessed with the “Methodological Index for Non‐Randomized Studies” (MINORS). The pooled efficacy rate of SDD protocol (defined as the proportion of patients discharged the same day of ablation among the patients who were planned for SDD) was calculated. Meanwhile, pooled major complication rates and early readmission or emergency department (ED) visit rates were evaluated in successful and planned SDD groups separately. Overall, 12 observational studies consisting of 18,065 catheter ablations were included, among which 7320 (40.52%) were discharged the same‐day after ablation. The pooled efficacy was 90.3% (95% confidence interval [CI] [82.7–96.0]). The major complication rates were 1.1% (95%CI [0.5–1.9]), and 0.7% (95% CI [0.0–3.1]) in planned SDD and successful SDD groups, respectively. In addition, readmission/ED visit rate were 3.0% (95%CI [0.9–6.1]), and 3.1% (95% CI [0.8–6.5]) in the same groups. There were no significant differences between planned SDD and overnight groups with respect to major complication rate (risk ratio = 0.70, 95%CI [0.35–1.42], p‐value = .369). The available data indicates that SDD after AF ablation is safe and efficient. Further prospective and randomized studies are warranted to elucidate the safety of SDD after AF ablation and develop a standardized SDD protocol.
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Affiliation(s)
- Sina Rashedi
- Department of Cardiac Electrophysiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Tavolinejad
- Department of Cardiac Electrophysiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.,Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sina Kazemian
- Department of Cardiac Electrophysiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.,Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahta Mardani
- Department of Cardiac Electrophysiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Masoudi
- Department of Cardiac Electrophysiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.,Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzad Masoudkabir
- Department of Cardiac Electrophysiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Cardiac Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Majid Haghjoo
- Department of Cardiac Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.,Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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10
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Prasitlumkum N, Cheungpasitporn W, Chokesuwattanaskul R, Kewcharoen J, Tokavanich N, Navaravong L, Jongnarangsin K. Comparison between same-day discharge and overnight stay after atrial fibrillation ablation: Systematic review and meta-analysis. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:2054-2066. [PMID: 34657314 DOI: 10.1111/pace.14380] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 08/08/2021] [Accepted: 10/11/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND In the modern era, atrial fibrillation (AF) ablation trend has been shifted toward same-day discharge (SDD), from a traditional overnight stay. Yet, recent studies have not well stated the safety profiles which remained poor-understood and dispersed. We hence performed systematic review and meta-analysis to assess the adverse outcomes of SDD in comparison with an overnight stay. METHODS Databases were searched through January 2021. Effect estimates from the individual studies were extracted and combined using random-effects, generic inverse variance method of der Simonian and Laird. The primary outcomes included total cumulative complications and immediate complications following AF ablation. RESULTS Ten observational studies were met our inclusion criteria, comprising of total population of 11,660 patients, with SDD 51.3%. For total cumulative complications, there were no differences observed between SDD and overnight stay (5.2% vs. 6.2%: pooled OR 0.77: 95% CI 0.55-1.08, p = .13 with I2 = 27.1%). In addition, comparable immediate complications were also demonstrated (5.2 % vs. 4.3: pooled OR 1.08: 95% CI 0.72-1.62, p = .718, with I2 = 37.3 %). CONCLUSION Our study suggested that SDD had similar complication rates, both total cumulative and immediate outcomes, compared with overnight stay in selected patients following AF ablation. Nevertheless, randomized control trials are warranted to validate the findings.
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Affiliation(s)
- Narut Prasitlumkum
- Division of Cardiology, University of California Riverside, Riverside, California, USA
| | | | - Ronpichai Chokesuwattanaskul
- Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Cardiac Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Center of Excellence in Arrhythmia Research Chulalongkorn University, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jakrin Kewcharoen
- Department of Cardiology, Loma Linda University, Loma Linda, California
| | - Nithi Tokavanich
- Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Center of Excellence in Arrhythmia Research Chulalongkorn University, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Leenhapong Navaravong
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Krit Jongnarangsin
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
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11
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Field ME, Goldstein L, Corriveau K, Khanna R, Fan X, Gold MR. Evaluating outcomes of same-day discharge after catheter ablation for atrial fibrillation in a real-world cohort. Heart Rhythm O2 2021; 2:333-340. [PMID: 34430938 PMCID: PMC8369301 DOI: 10.1016/j.hroo.2021.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background As same-day discharge (SDD) after catheter ablation (CA) for atrial fibrillation (AF) is increasingly utilized, it is important to further investigate this approach. Objective To investigate the safety and efficacy of SDD after CA for AF in a large nationwide administrative sample. Methods The IBM MarketScan Commercial Claims and Encounters database was used to identify adult patients under 65 years undergoing CA for AF (2016-2020). Eligible patients were indexed to date of first CA and classified into SDD or overnight stay (ONS) groups based on length of service. A 1:3 propensity score matching was used to create comparable SDD:ONS samples. Study outcomes were CA-related complications within 30 days after index procedure and AF recurrence within 1 year. Cox proportional hazards models were estimated for outcome comparison. Results In the postmatch 30-day cohort, there were 1610 SDD and 4637 ONS patients with mean age 56.1 (± 7.6) years. There was no significant difference in composite 30-day postprocedural complication rate between SDD and ONS groups (2.7% vs 2.8%, respectively; P = .884). The most common complications were cerebrovascular events (0.7% vs 0.7%; P = .948), vascular access events (0.6% vs 0.6%; P = .935), and pericardial complications (0.6% vs 0.5%; P = .921). Further, no significant difference in composite AF recurrence rate at 1 year was observed among SDD and ONS groups (10.2% vs 8.8%; hazard ratio = 1.167; 95% confidence interval 0.935-1.455; P = .172). Conclusion In a large, propensity-matched, real-world sample, SDD appears to be safe and have similar outcomes compared with overnight observation following CA for AF.
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Affiliation(s)
- Michael E. Field
- Medical University of South Carolina, Charleston, South Carolina
- Address reprint requests and correspondence: Dr Michael E. Field, Department of Medicine, Medical University of South Carolina, 30 Courtenay Dr, MSC592, Charleston, SC 29425.
| | - Laura Goldstein
- Medical Devices Franchise Health Economics and Market Access, Johnson & Johnson, Irvine, California
| | - Kevin Corriveau
- Medical Devices Franchise Health Economics and Market Access, Johnson & Johnson, Irvine, California
| | - Rahul Khanna
- Medical Device Epidemiology and Real-World Data Sciences, Johnson and Johnson, New Brunswick, New Jersey
| | - Xiaozhou Fan
- Medical Device Epidemiology and Real-World Data Sciences, Johnson and Johnson, New Brunswick, New Jersey
| | - Michael R. Gold
- Medical University of South Carolina, Charleston, South Carolina
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12
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Khurshid S, Chen W, Bode WD, Wasfy JH, Chhatwal J, Lubitz SA. Comparative Effectiveness of Implantable Defibrillators for Asymptomatic Brugada Syndrome: A Decision-Analytic Model. J Am Heart Assoc 2021; 10:e021144. [PMID: 34387130 PMCID: PMC8475040 DOI: 10.1161/jaha.121.021144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/28/2021] [Indexed: 11/16/2022]
Abstract
Background Optimal management of asymptomatic Brugada syndrome (BrS) with spontaneous type I electrocardiographic pattern is uncertain. Methods and Results We developed an individual-level simulation comprising 2 000 000 average-risk individuals with asymptomatic BrS and spontaneous type I electrocardiographic pattern. We compared (1) observation, (2) electrophysiologic study (EPS)-guided implantable cardioverter-defibrillator (ICD), and (3) upfront ICD, each using either subcutaneous or transvenous ICD, resulting in 6 strategies tested. The primary outcome was quality-adjusted life years (QALYs), with cardiac deaths (arrest or procedural-related) as a secondary outcome. We varied BrS diagnosis age and underlying arrest rate. We assessed cost-effectiveness at $100 000/QALY. Compared with observation, EPS-guided subcutaneous ICD resulted in 0.35 QALY gain/individual and 4130 cardiac deaths avoided/100 000 individuals, and EPS-guided transvenous ICD resulted in 0.26 QALY gain and 3390 cardiac deaths avoided. Compared with observation, upfront ICD reduced cardiac deaths by a greater margin (subcutaneous ICD, 8950; transvenous ICD, 6050), but only subcutaneous ICD improved QALYs (subcutaneous ICD, 0.25 QALY gain; transvenous ICD, 0.01 QALY loss), and complications were higher. ICD-based strategies were more effective at younger ages and higher arrest rates (eg, using subcutaneous devices, upfront ICD was the most effective strategy at ages 20-39.4 years and arrest rates >1.37%/year; EPS-guided ICD was the most effective strategy at ages 39.5-51.3 years and arrest rates 0.47%-1.37%/year, and observation was the most effective strategy at ages >51.3 years and arrest rates <0.47%/year). EPS-guided subcutaneous ICD was cost-effective ($80 508/QALY). Conclusions Device-based approaches (with or without EPS risk stratification) can be more effective than observation among selected patients with asymptomatic BrS. BrS management should be tailored to patient characteristics.
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Affiliation(s)
- Shaan Khurshid
- Cardiology DivisionMassachusetts General HospitalBostonMA
- Cardiovascular Research CenterMassachusetts General HospitalBostonMA
| | - Wanyi Chen
- Institute for Technology AssessmentMassachusetts General HospitalBostonMA
| | - Weeranun D. Bode
- Cardiac Arrhythmia ServiceMassachusetts General HospitalBostonMA
| | - Jason H. Wasfy
- Cardiology DivisionMassachusetts General HospitalBostonMA
- Cardiovascular Research CenterMassachusetts General HospitalBostonMA
| | - Jagpreet Chhatwal
- Institute for Technology AssessmentMassachusetts General HospitalBostonMA
| | - Steven A. Lubitz
- Cardiology DivisionMassachusetts General HospitalBostonMA
- Cardiovascular Research CenterMassachusetts General HospitalBostonMA
- Cardiac Arrhythmia ServiceMassachusetts General HospitalBostonMA
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13
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Field ME, Goldstein L, Corriveau K, Khanna R, Fan X, Gold MR. Same-day discharge after catheter ablation in patients with atrial fibrillation in a large nationwide administrative claims database. J Cardiovasc Electrophysiol 2021; 32:2432-2440. [PMID: 34324239 DOI: 10.1111/jce.15193] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Catheter ablation (CA) is a common treatment for atrial fibrillation (AF). This study evaluated outcomes of same day discharge (SDD) versus overnight stay (ONS) among AF patients undergoing outpatient CA. METHODS The Optum SES Clinformatics Extended Data Mart database was used to identify patients ≥18 years of age undergoing outpatient CA for AF (2016-2020). Eligible patients were indexed to the date of first CA and classified into SDD and ONS groups based on the length of service. A 1:3 propensity score matching was used to create comparable SDD:ONS samples. The primary safety outcome was CA-related complications within 30 days of index procedure. The primary efficacy outcome was AF recurrence within 1 year. Cox proportional hazards models were estimated for outcome comparison. RESULTS In the postmatch 30-day cohort for safety evaluation, there were 6600 patients (1660 [25.2%] SDD; 4940 [74.8%] ONS), with a mean age of 66.6 years. There was no significant difference in the 30-day composite rate of postablation complications (4.7% [78/1660] vs. 3.8% [187/4940]; p = 0.100) and 1-year composite rate of AF recurrence (14.3% [142/996] vs. 14.5% [430/2972]; p = 0.705) between the SDD and ONS groups. CONCLUSION This study demonstrated that SDD following CA to treat patients with AF is safe, with low rates of postablation complications and AF recurrence, which were comparable to rates in patients with an ONS after CA.
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Affiliation(s)
- Michael E Field
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Laura Goldstein
- Johnson & Johnson Medical Devices, Franchise Health Economics and Market Access, Irvine, California, USA
| | - Kevin Corriveau
- Johnson & Johnson Medical Devices, Franchise Health Economics and Market Access, Irvine, California, USA
| | - Rahul Khanna
- Medical Device Epidemiology & Real-World Data Science, Johnson and Johnson, New Brunswick, New Jersey, USA
| | - Xiaozhou Fan
- Medical Device Epidemiology & Real-World Data Science, Johnson and Johnson, New Brunswick, New Jersey, USA
| | - Michael R Gold
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
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14
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Sahashi Y, Kawamura I, Aikawa T, Takagi H, Briasoulis A, Kuno T. Safety and feasibility of same-day discharge in patients receiving pulmonary vein isolation-systematic review and a meta-analysis. J Interv Card Electrophysiol 2021; 63:251-258. [PMID: 33630213 DOI: 10.1007/s10840-021-00967-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 02/15/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this systematic review and meta-analysis was to evaluate the feasibility and safety of a same-day discharge protocol following pulmonary vein isolation (PVI). METHODS PubMed and Embase were systematically investigated from the inception to 20 July 2020. Studies on safety and feasibility of PVI for atrial fibrillation (AF) were included. Study-specific estimates were combined using one-group meta-analysis with a random-effects model. RESULTS Seven observational studies investigating the safety and feasibility of same-day discharge protocols were identified. Of a total of 3656 patients who have undergone PVI for AF, the overall complication rate was 0.80% (95% confidence interval [CI], 0.20-1.40%). The readmission within 30-day following same-day discharge protocol occurred at a pooled rate of 3.6% (95% CI, 0.0-8.4%). Frequent complications following the procedure were complications related to vascular access (0.38%; 95% CI, 0.18-0.58%), and phrenic nerve injury (0.19%; 95% CI, 0.05-0.33%). The reported complications in SDD group were mainly based on results among patients without perioperative complications. CONCLUSIONS The introduction of same-day discharge strategies might be safe and feasible in selected patients given the reported complication and re-admission rates in the current practice. Further prospective studies are needed to confirm these findings.
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Affiliation(s)
- Yuki Sahashi
- Department of Cardiology, Gifu University Graduate School of Medicine, Gifu, Japan.,Department of Health Data Science, Graduate School of Data Science, Yokohama City University, Yokohama, Japan
| | - Iwanari Kawamura
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tadao Aikawa
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Alexandros Briasoulis
- Division of Cardiovascular Diseases, University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Toshiki Kuno
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, First Avenue, 16th Street, New York, NY, 10003, USA.
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15
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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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16
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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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17
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Efficacy and Safety of Same-Day Discharge for Atrial Fibrillation Ablation. JACC Clin Electrophysiol 2020; 6:609-619. [DOI: 10.1016/j.jacep.2020.02.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 01/21/2020] [Accepted: 02/13/2020] [Indexed: 11/17/2022]
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18
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Reddy SA, Nethercott SL, Chattopadhyay R, Heck PM, Virdee MS. Safety, Feasibility and Economic Impact of Same-Day Discharge Following Atrial Fibrillation Ablation. Heart Lung Circ 2020; 29:1766-1772. [PMID: 32317135 DOI: 10.1016/j.hlc.2020.02.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/24/2020] [Accepted: 02/28/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND The widely accepted model for atrial fibrillation (AF) ablation involves overnight hospital stay post-procedure. Day case AF ablation has been carried out at Royal Papworth Hospital (RPH) since early 2017. We evaluated the feasibility, safety and efficacy of day case AF ablation at RPH. METHOD This was a retrospective, single-centre study of consecutive AF ablations at RPH between March 2017 and April 2018. Demographic, procedural and outcome data were analysed. RESULTS Over the study period, 452 AF ablations were performed in 448 patients. One hundred and twenty-nine (129) (28.5%) were planned day cases; of these 128 were discharged on the same day. Two hundred and eighty-three (283) procedures resulted in at least one night admission. There was no significant difference in age or sex between the groups. Of note, day case procedures were significantly shorter, more likely to commence in the morning and less likely to require general anaesthetic than overnight stays. Patients listed as day cases also had less far to travel. The overall complication rate was 3.3%, with no significant difference between groups. Follow-up data was available for 448 cases (99.1%). Procedural success rates were comparable between groups. The overall cost saving attributable to providing AF ablation as a day case was £67,200 over the 13-month period. CONCLUSIONS Day case AF ablation is efficacious and associated with a low event rate, even without strict standardisation of patient selection or procedural protocols, in a high-volume centre. Substantial reduction in health care expenditure can be achieved with more widespread implementation of outpatient AF ablation.
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Affiliation(s)
- S Ashwin Reddy
- Royal Papworth Hospital, Cambridge Biomedical Campus, Cambridge, UK.
| | | | | | - Patrick M Heck
- Royal Papworth Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - Mohan S Virdee
- Royal Papworth Hospital, Cambridge Biomedical Campus, Cambridge, UK
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19
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Safety of uninterrupted direct oral anticoagulants for ambulatory common atrial flutter catheter ablation: A propensity score–matched cohort study. Heart Rhythm 2020; 17:592-599. [DOI: 10.1016/j.hrthm.2019.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Indexed: 11/20/2022]
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20
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Ignacio DM, Jarma DJJ, Nicolas V, Gustavo D, Leandro T, Milagros C, Vasquez E, Alberto G, Santiago R, Gaston A, Fernando S. Current Safety of Pulmonary Vein Isolation in Paroxysmal Atrial Fibrillation: First Experience of Same Day Discharge. J Atr Fibrillation 2018; 11:2077. [PMID: 31139283 DOI: 10.4022/jafib.2077] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 08/19/2017] [Accepted: 08/09/2018] [Indexed: 11/10/2022]
Abstract
Introduction Pulmonary vein isolation (PVI) has become the standard treatment of symptomatic atrial fibrillation. Patients remain hospitalized for at least 24 hours to detect potential complications in most centers worldwide. There is still a lack of data about the safety of same-day discharge. Objectives The aim was to compare the safety of same-day discharge with next day discharge after overnight monitoring.The rate of new hospitalization and visits to the emergency department and the costeffectiveness of the same-day discharge approach were evaluated. Methods We conducted a longitudinal and prospective cohort study of all the consecutive patients undergoing scheduled pulmonary vein ablation of either paroxysmal or persistent atrial fibrillation (AF). The complications were recorded by type and time of occurrence. Results Overall 58 patients were discharged within the same day and 137 patients stayed overnight after PVI. There were no significant differences in demography, comorbidities and other predictors of complications. No complications were reported after the sixth hour. We observed a significant difference in the number of visits to emergency department: 15.5% for the same-day discharge group vs. 30.7% for the overnight hospitalization group (p 0.03). Only 50% of the reasons to visit the emergency department were cardiovascular causes. No cases of pericardial tamponade were reported and none of the patients required new hospitalization up to 30 days of follow up. Conclusions Same-day discharge after PVI is feasible and cost-effective. This is the first study analyzing the experience in patients undergoing AVP,considering acare based component to this procedure. This approach would provide significant benefits for patients and health care providers.
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Affiliation(s)
| | | | | | | | - Tomas Leandro
- Instituto Cardiovascular de Buenos Aires, Electrophysiology
| | - Caro Milagros
- Instituto Cardiovascular de Buenos Aires, Electrophysiology
| | - Elias Vasquez
- Instituto Cardiovascular de Buenos Aires, Electrophysiology
| | | | | | - Albina Gaston
- Instituto Cardiovascular de Buenos Aires, Electrophysiology
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21
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Katritsis DG, Boriani G, Cosio FG, Hindricks G, Jaïs P, Josephson ME, Keegan R, Kim YH, Knight BP, Kuck KH, Lane DA, Lip GYH, Malmborg H, Oral H, Pappone C, Themistoclakis S, Wood KA, Blomström-Lundqvist C, Gorenek B, Dagres N, Dan GA, Vos MA, Kudaiberdieva G, Crijns H, Roberts-Thomson K, Lin YJ, Vanegas D, Caorsi WR, Cronin E, Rickard J. European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardiaca y Electrofisiologia (SOLAECE). Europace 2018; 19:465-511. [PMID: 27856540 DOI: 10.1093/europace/euw301] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Demosthenes G Katritsis
- Athens Euroclinic, Athens, Greece; and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Giuseppe Boriani
- Cardiology Department, Modena University Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | - Pierre Jaïs
- University of Bordeaux, CHU Bordeaux, LIRYC, France
| | | | - Roberto Keegan
- Hospital Privado del Sur y Hospital Español, Bahia Blanca, Argentina
| | - Young-Hoon Kim
- Korea University Medical Center, Seoul, Republic of Korea
| | | | | | - Deirdre A Lane
- Asklepios Hospital St Georg, Hamburg, Germany.,University of Birmingham Institute of Cardiovascular Science, City Hospital, Birmingham, UK; and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Gregory Y H Lip
- University of Birmingham Institute of Cardiovascular Science, City Hospital, Birmingham, UK; and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Helena Malmborg
- Department of Cardiology and Medical Science, Uppsala University, Uppsala, Sweden
| | - Hakan Oral
- University of Michigan, Ann Arbor, MI, USA
| | - Carlo Pappone
- IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | | | | | - Bulent Gorenek
- Cardiology Department, Eskisehir Osmangazi University, Eskisehir, Turkey
| | | | - Gheorge-Andrei Dan
- Colentina University Hospital, 'Carol Davila' University of Medicine, Bucharest, Romania
| | - Marc A Vos
- Department of Medical Physiology, Division Heart and Lungs, Umc Utrecht, The Netherlands
| | | | - Harry Crijns
- Mastricht University Medical Centre, Cardiology & CARIM, The Netherlands
| | | | | | - Diego Vanegas
- Hospital Militar Central - Unidad de Electrofisiologìa - FUNDARRITMIA, Bogotà, Colombia
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22
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Havryliuk Y, Setton R, Carlow JJ, Shaktman BD. Symptomatic Fibroid Management: Systematic Review of the Literature. JSLS 2018; 21:JSLS.2017.00041. [PMID: 28951653 PMCID: PMC5600131 DOI: 10.4293/jsls.2017.00041] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background and Objectives: Symptomatic uterine fibroids are a societal and healthcare burden with no clear consensus among medical professionals as to which procedural treatment is most appropriate for each symptomatic patient. Our purpose was to determine whether recommendations can be made regarding best practice based on review and analysis of the literature since 2006. Database: A systematic search of journal articles relevant to the treatment of symptomatic uterine fibroids was performed within PubMed, clinical society websites, and medical device manufacturers' websites. All clinical trials published in English, representing original research, and reporting clinical outcomes associated with interventions for the management of symptomatic uterine fibroids were considered. Each article was screened and selected based on study type, content, relevance, American College of Obstetricians and Gynecologists score, and internal/external validity. Outcomes of interest were patient baseline characteristics, fibroid characteristics, procedural details, complications, and long-term follow-up. Random-effects meta-analyses were used to test the quantitative data. Assessment of 143 full-length articles through January 2016 produced 45 articles for the quantitative analysis. The weighted combined results from hysterectomy trials were compared with those from uterine-preserving fibroid studies (myomectomy, uterine artery embolization, laparoscopic radiofrequency ablation, and magnetic resonance-guided focused ultrasound). Conclusion: We explored trends that might guide clinicians when counseling patients who need treatment of symptomatic fibroids. We found that fibroid therapy is trending toward uterine-conserving treatments and outcomes are comparable across those treatments. Since minimally invasive options are increasing, it is important for the clinician to provide the patient with evidence-based therapeutic strategies.
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Affiliation(s)
- Yelena Havryliuk
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York, USA
| | - Robert Setton
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York, USA
| | | | - Barry D Shaktman
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York, USA
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23
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Tripathi B, Arora S, Kumar V, Abdelrahman M, Lahewala S, Dave M, Shah M, Tan B, Savani S, Badheka A, Gopalan R, Shantha GPS, Viles-Gonzalez J, Deshmukh A. Temporal trends of in-hospital complications associated with catheter ablation of atrial fibrillation in the United States: An update from Nationwide Inpatient Sample database (2011-2014). J Cardiovasc Electrophysiol 2018; 29:715-724. [DOI: 10.1111/jce.13471] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 01/11/2018] [Accepted: 01/31/2018] [Indexed: 01/08/2023]
Affiliation(s)
| | | | - Varun Kumar
- Guthrie Robert Packer Hospital; Sayre PA USA
| | | | - Sopan Lahewala
- RWJ Barnabas health/Jersey City Medical Center; Jersey City NJ USA
| | - Mihir Dave
- Icahn School of Medicine at Mount Sinai; New York NY USA
| | - Mahek Shah
- Lehigh Valley Hospital; Allentown PA USA
| | - Bryan Tan
- Icahn School of Medicine at Mount Sinai; New York NY USA
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24
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Krämer B, Hahn M, Taran FA, Kraemer D, Isaacson KB, Brucker SY. Interim analysis of a randomized controlled trial comparing laparoscopic radiofrequency volumetric thermal ablation of uterine fibroids with laparoscopic myomectomy. Int J Gynaecol Obstet 2015; 133:206-11. [DOI: 10.1016/j.ijgo.2015.10.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 10/09/2015] [Accepted: 12/18/2015] [Indexed: 11/15/2022]
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