Same day discharge catheter ablation procedures, initial German experience

Background: The recent technological innovations and the increased operators’ experienced lead to a substantial improvement of the safety and efficacy profile of invasive electrophysiology (EP) interventions. This observation and the increased number of procedures performed worldwide, as well as the limited healthcare resources make same day discharge (SDD) interventions of particular interest. However, inpatient catheter ablation remains the gold standard in most European countries, and Germany. 

Purpose: To evaluate the first German SDD experience for EP interventions.

Methods: Patients undergoing interventional EP procedures with a maximum of two venous accesses (VA) were discharged on the day of procedure, after the haemostasis and ambulation were proven. In general patients <80 years old, without severe comorbidities and living at a reasonable distance from the hospital were considered suitable for SDD interventions. Vascular closure system (VCS) or a figure-of-eight suture followed by compressive bandage application were used to achieve haemostasis. All patients were scheduled for an outpatient visit the day after the procedure (groin examination, suture removal, echocardiography, holter). During 30 days of follow up, postprocedural emergency department (ED) visits, unplanned ambulatory presentations, and readmissions were assessed. 

Results: A total of 23 SDD EP interventions  (13% females, mean age 60.3 ± 12.2, mean BMI 28.6 ± 5.3) between September 2022 and September 2023 were included.  Of them 60.9% had paroxysmal atrial fibrillation, 43.5% arterial hypertension, 17.4% diabetes mellitus, 8.7% coronary artery disease and 4.3% chronic kidney disease. The mean GFR was 80.86 ± 17.6 mL/min/1.73m2 and the mean left ventricular ejection fraction 52 ± 5.2%. Seven (31.8%) patients had a CHA2DS2-VASc score of at least 3. Twenty (86.95%) patients underwent 1st-do pulmonary vein isolation (PVI) by means of cryoenergy (70%), pulsed field ablation (PFA; 25%) or laser energy (5%), while one patient underwent a radiofrequency-based cavotricuspid isthmus ablation and two patient a left atrial appendage closure intervention. Three patients undergoing PFA-based PVI received only one VA, while all other procedures were performed using 2 VAs. In 68.2% of procedures haemostasis was achieved by means of VCS. All interventions were successful. One (4.3%) minor intraprocedural complication was noted (phrenic nerve palsy). The median time between the removal of the last vascular sheath and the discharge was 5:52 (4:52; 6:07) h: min. A total of 15 (65.2%) patients presented the next day in our clinic for groin inspection. Two VA-related haematomas were reported, no one requiring medical intervention. One patient was readmitted 2 days postprocedural due to hemodynamically relevant pericardial effusion and underwent pericardial punction and drainage with favourable evolution. Another patient had an ED visit two days postprocedural due to haemoptysis, while two patients had unplanned ambulatory presentations (flecainid intolerance and cardioversion) and another 2 unplanned readmissions, unrelated to the EP procedure. 

Conclusions: For selected patients undergoing EP procedures SDD seems to be safe and feasible in this single centre study. This approach has the potential to increase healthcare capabilities, patients comfort and to reduce the cost of medical care.