Same-day discharge protocol identifies patients who respond well to AF ablation
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Key takeaways:
- Patients undergoing catheter ablation for atrial fibrillation who met certain criteria were usually able to go home the same day.
- Patients who met the same-day criteria tended to have better outcomes.
Use of a standardized protocol identified candidates for same-day discharge after catheter ablation for atrial fibrillation and also predicted procedural outcomes, researchers reported at Heart Rhythm 2023.
The researchers conducted an analysis of 2,332 patients from the REAL-AF registry of people with paroxysmal or persistent AF who underwent radiofrequency catheter ablation (Thermocool SmartTouch or Thermocool SmartTouch SF, Biosense Webster).
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“In 2021, the REAL-AF team developed a same-day discharge protocol, and we implemented this protocol in a matched-cohort single-center study,” Carolina Hoyos, MD, electrophysiology research fellow at Brigham and Women’s Hospital, told Healio. “After that, we arranged to implement the REAL-AF same-day discharge (SDD) protocol in all participating sites of the registry in order to determine its safety and efficacy in a prospective multicenter fashion.”
The protocol eligibility criteria were stable anticoagulation, absence of bleeding history, left ventricular ejection fraction > 40%, no pulmonary disease, no procedures within 60 days and BMI < 35 kg/m2. Among the cohort, 85% met the criteria (SDD group) and the rest did not (non-SDD group). The SDD group was further divided into those who had successful SDD after their procedure (S-SDD group, 86.1% of the SDD group) and those who did not (U-SDD group) based on the discharge criteria (no periprocedural complications, stable hemodynamics, able to ambulate or tolerate liquids/food, purse-string suture removed, if applicable, and appropriate social support).
Compared with the SDD group, the non-SDD group had longer procedural times (113 minutes vs. 93 minutes; P < .001) and ablation times (24.5 minutes vs. 21.4 minutes; P < .001), according to the researchers. Likewise, compared with the S-SDD group, the U-SDD group had longer procedural times (98 minutes vs. 92 minutes; P = .038) and ablation times (23.2 minutes vs. 21.1 minutes; P = .005).
The non-SDD group had more acute complications, mostly pericarditis and vascular access complications, compared with the SDD group (2.9% vs. 0.8%; P < .001) without difference in the readmission rate within the next 30 days after the procedure in the non-SDD vs. SDD groups (0.9% vs. 0.8%, respectively; P = 0.924), and trended toward being more likely to have an arrhythmia recurrence at 12 months (30.8% vs. 22.3%; P = .064), Hoyos and colleagues found.
“Based on a well-designed SDD protocol, patients undergoing catheter ablation of AF may be safely and effectively discharged on the same day of the procedure without an increased risk of complications or readmission rate,” Hoyos told Healio. “This protocol was designed to provide same-day discharge after catheter ablation of paroxysmal or persistent AF. Future trials are needed to evaluate frequently used interventions, such as sutured-mediated devices, which may improve the success rate of SDD. Our results implementing the REAL-AF SDD protocol may have a significant impact on health care resource utilization and improve patient satisfaction at the discharge time.”
The presentation was the highest-scoring abstract for women in electrophysiology and the highest-scoring abstract in the quality improvement category at Heart Rhythm 2023.
Editor's Note: This article was modified on June 6, 2023 to reflect updates to the data.
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Hoyos C, et al. Abstract QI-452785-1. Presented at: Heart Rhythm 2023; May 19-21, 2023; New Orleans (hybrid meeting).
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