https://doi.org/10.1007/s00392-024-02526-y
1Universitätsklinikum Schleswig-Holstein Klinik für Rhythmologie Lübeck, Deutschland; 2Asklepios Klinik Altona Kardiologie und Internistische Intensivmedizin Hamburg, Deutschland; 3Cardiance Clinic Pfäffikon SZ, Schweiz
Background: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in adults and is associated with an increased morbidity and mortality. The incidence of AF is expected to increase in the next years, posing a high burden on the already limited healthcare resources. The substantial technological progress in the last years, as well as the increased operators experience have improved the safety and efficacy of catheter ablations, making same day discharge (SDD) interventions possible, and offering a promising solution to better administer healthcare resources. However, inpatient catheter ablation remains the gold standard in most European countries and Germany is no exception.
Purpose: To evaluate the initial German experience regarding the safety and efficacy of catheter ablation procedures utilizing SDD.
Methods: Patients undergoing interventional catheter ablation procedures were discharged on the day of the procedure, after achieving haemostasis and ambulation. In general patients <85 years old, without severe comorbidities and living at a reasonable distance (< 50 km) from the hospital were considered suitable. The haemostasias was achieved by means of figure-of-eight suture followed by manual compression, or by means of venous closure systems (VCS). An outpatient visit was scheduled on the first day postprocedural (inspection of the groin, suture removal, exclusion of pericardial effusion and Holter ECG). During 30 days of follow up, postprocedural emergency department visits, unplanned ambulatory presentations, and readmissions were assessed.
Results: Between September 2022 and May 2024, a total of 44 SDD catheter ablation interventions were included (20.5% females, mean age 59.0 ± 12.8, mean BMI 28.4 ± 5.1) (Table 1).
A total of 36 (81.8%) patients underwent pulmonary vein isolation (PVI) procedures (72.2% cryoablation, 5.6% radiofrequency ablation, 2.8% laser ablation and 19.4% pulsed field ablation (PFA)), three (6.8%) patients PVI and cavotricuspid isthmus (CTI) ablation procedures, and two (4.5%) a CTI ablation alone. Another three (6.8%) patients underwent a supraventricular tachycardia (SVT) ablation.
Eight (18.2%) patients undergoing PVI by means of cryoenergy (50%) or PFA (50%) received only one venous puncture, while 63.6% two and 18.2% three venous punctures. A venous closure system (VCS) was used in 52.3% patients. All procedures were successful and only one intraprocedural complication was noted (phrenic nerve palsy). The mean time between the end of the procedure and discharge was 5:29 ± 0:59 h:min. Among the 34 (77.3%) patients presenting on the next day, 4 presented groin haematomas without further interventions, while one patient showed a minimal pericardial effusion treated conservatively and another one cough with minimal bleeding.
During the 30 days follow-up, three patients present in the emergency department, one because of haemoptysis and two because of an arrhythmia recurrence, while another three patients had unplanned ambulatory visits (flecainide intolerance and arrhythmia recurrence). Two unplanned readmissions were reported, one due to upper respiratory tract infection and one due to arrhythmia recurrence.
Conclusions: In this prospective single centre study, SDD catheter ablations were shown to be safe and feasible. This approach has the potential to increase healthcare capabilities, patients’ comfort and to optimize the use of healthcare resources.