The safety and economic advantages of day case electrophysiologic studies

Routine Unselected Access to Day Case Electrical Cardioversion of Persistent Atrial Fibrillation: Anticoagulant Preparation is the Key Factor

Objectives: To determine the routine efficacy of a day case cardioversion system operating in a remote geographical area with an unselected case referral base and a proportion of direct GP access. Design: Prospective analysis of all admitted cases in a 13 week period. Participants: 47 consecutive patients admitted for 49 planned episodes of electrical cardioversion. Measurements: Pre procedural investigations and preparation, immediate and three-month outcome of rhythm following ECV Results: We found a predominant use by the cardiac unit despite working within a general medical service unit suggesting low case selection from non-cardiac sources. We suspected and confirmed a high rate of point of care treatment cancellation. Poor management of anticoagulation was the dominant reason for canceling planned treatment. Procedural preparation in terms of anti arrhythmic drug therapy and investigations seemed well preserved. Conclusion: New strategies for initiating and sustaining adequate outpatient warfarin therapy are needed to allow such systems to operate efficiently.

Cost effectiveness of day stay versus inpatient radiofrequency (RF) ablation for the treatment of supraventricular tachyarrhythmias

BACKGROUND

It is well established that radiofrequency (RF) ablation is the most cost effective treatment strategy for patients with supraventricular tachycardia. Previous cost estimates assumed at least an overnight stay following RF ablation. Day stay RF ablation however appears to be a safe alternative.

AIMS

The aim of this study was to compare day stay and inpatient catheter ablation in terms of cost, efficacy and safety.

METHODS

This was a retrospective cost effectiveness analysis. The study population consisted of 25 consecutive patients who underwent day stay RF ablation and 25 consecutive patients who underwent inpatient RF ablation (historical controls). Economic analysis was based upon a detailed clinical costing.

RESULTS

The mean overall cost per patient of inpatient RF ablation in 1994 Australian dollar values is $2354 (SD, $642) compared with $1876 (SD, $595) for day stay RF ablation (p < 0.01). Day stay RF ablation is a cost effective alternative to inpatient RF ablation.

Radiofrequency ablation: a review of its application and nursing considerations

Radiofrequency ablation (RFA), a therapeutic electrophysiological procedure, has become the treatment of choice for a number of cardiac arrhythmias. These arrhythmias include those of anomalous pathways, as seen in AV nodal re-entry tachycardia and Wolff-Parkinson-White syndrome, and re-entry tachycardias of atrial and ventricular origins. This paper discusses the mechanism of RFA and the physiology of re-entry circuits, and outlines the cardiac arrhythmias treated by RFA. The nursing responsibilities associated with the RFA procedure--including patient education, observation for potential complications, and other peri- and post-procedure considerations--are then addressed.