Same day discharge after atrial fibrillation ablation is feasible and safe. Results of a prospective study in 1015 patients

Background

Atrial fibrillation (AF) ablation is the standard treatment for symptomatic paroxysmal and persistent AF. It is a common practice for patients to stay overnight after the ablation for observation of possible complications. Thus, increasing volume of procedures places a significant strain on institutions. To tackle this issue, our institution developed a same-day discharge (SDD) protocol for AF ablation.

Purpose

To assess the feasibility and safety of the SDD protocol after at least four-hour observation in patients undergoing radiofrequency ablation (RFA) for AF.

Methods

A SDD protocol was implemented in our institution in March 2019. We conducted a prospective observational study that included all consecutive patients who underwent ablation for AF until January 2021. A detailed workflow setup provided in the figure. To compare means the Mann Whitney U test, and for categorical variables – χ2 test were used. The difference was significant when p<0.05.

Results

A total of n=1015 patients underwent RFA in the study period. Of those, same-day discharge was feasible in n=751 (74.1%) and n=264 stayed overnight. The mean age (SDD 62.5 SD 8.8 years vs overnight-stay 64.1 SD 9.2 years, p=0.105) and gender distribution (males SDD 46.8% vs overnight-stay 39.8%, p=0.265) did not differ between the two groups. In the SDD group no patients were readmitted for complications within 24 hours after the ablation. A severe complication was defined as pericardial effusion with drainage, pulmonary oedema, thromboembolic event and vascular complication needing surgical intervention. In total 3.0% of all patients experienced a severe complication. The main reasons for staying overnight were small groin hematoma without intervention (18.9%), nausea (14.4%) and logistic issues (32.2%). The 30-day hospital readmission rate was insignificantly higher in the overnight-stay group (19.4% vs 28.0%, p=0.113). The most common reasons for readmission were arrhythmias (SDD 10.1% vs overnight-stay 20.5%) and chest pain (SDD 7.6% vs overnight-stay 2.4%). One late pericardial effusion with drainage on day 10 after the ablation was noted in the SDD group.

Conclusion

Same-day discharge in patients after RFA for AF is feasible and safe with an observational period of at least four hours and immediate transthoracic echocardiography after the procedure.

Funding Acknowledgement

Type of funding sources: None.

Prophylactic cavotricuspid isthmus block during atrial fibrillation ablation in patients without atrial flutter: a randomised controlled trial

OBJECTIVES

This randomised trial evaluated if patients with atrial fibrillation (AF) and no history of atrial flutter (AFL) had any benefit of prophylactic cavotricuspid isthmus block (CTIB) in addition to circumferential pulmonary vein ablation (CPVA).

METHODS

149 patients with AF (54% paroxysmal) were randomised to CPVA and CTIB (group CTIB+, n = 73) or CPVA alone (group CTIB-, n = 76). Patients were followed for 12 months with repetitive 7-day Holter monitoring after 3, 6 and 12 months.

RESULTS

Six patients (4%) had cardiac tamponade, and one patient had a stroke. No difference was found in the cumulative AFL-free rate between the two treatment groups (CTIB+: 88% vs CTIB-: 84%, hazard ratio (HR) 0.80, 95% CI (0.34 to 1.90), p = 0.61). There was no difference in the cumulative AF-free rate between the groups (CTIB+: 34% vs CTIB-: 32%, HR 0.93, 95% CI (0.63 to 1.38), p = 0.71). Overall, 33% of the patients were free of AF after a single procedure. Including reprocedures, a complete or partial beneficial effect was noted in 62% of the patients at 12 months. At 12-month follow-up, 24 (50%) patients with documented AF or AFL in the Holter recordings were asymptomatic.

CONCLUSIONS

It was not possible to demonstrate any beneficial effect of CTIB in addition to CPVA with regard to AFL or AF recurrences during follow-up. Repetitive long-term Holter monitoring demonstrated a 33% rate of freedom from AF during a 1-year follow-up. Including additional CPVA procedures, a clinical effect was noted in 62% of the patients at 12 months. Patients with AF or AFL recurrences were often asymptomatic.