Same-day versus next-day discharge strategies for left atrial ablation procedures: A parallel, intra-institutional comparison of safety and feasibility

• Authors: Matthew T Brown, Emory University Hospital; Mary M Pelling, Emory University Hospital; Faisal Merchant, Emory University; Soroosh Kiani, Emory University; Mikhael F El-Chami, Emory Healthcare; Angel Leon, Emory University; Stacy Westerman, Emory University; Anand Shah, Emory University; Donna Wise, Emory University Hospital; Michael Lloyd, Emory University
• Journal Title: Journal of Atrial Fibrillation
• Volume: Volume 13, Number 5
• Publisher: Cardiofront | 2021-02-01, Pages 2466-2466
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.4022/jafib.2466
• Subjects: Health Sciences, General
• Keywords: Ablation; Atrial fibrillation; Complications; Discharge strategy; Hospitalization; Left atrial

Abstract

Background: Head-to-head comparative data for the postoperative care of patients undergoing left atrial ablation procedures are lacking. Objective: We sought to investigate complication and readmission rates between patients undergoing same-day (SD) or next-day (ND) discharges for ablative procedures in the left atrium, primarily atrial fibrillation (AF). Methods: Two electrophysiology centers simultaneously perform left atrial ablations with differing discharge strategies. We identified all patients who underwent left atrial ablation from August 2017 to August 2019 (n = 409) undergoing either SD (n = 210) or ND (n = 199) discharge protocols. We analyzed any clinical events that resulted in procedural abortion, extended hospitalization, or readmission within 72 hours. Results: The primary endpoint of complication and readmission rate was similar between SD and ND discharge (14.3% vs 12.6%, p = 0.665). Rates of complications categorized as major (2.4% vs 3.0%, p = 0. 776) and minor (11.9% vs 9.5%, p = 0.524) were also similar. Multivariable regression modeling revealed no significant correlation between discharge strategy and complication/readmission occurrence (OR 1.565 [0.754 – 3.248], p = 0.23), but a positive association of hypertension and procedure duration (OR 3.428 [1.436 – 8.184], p = 0.006) and (OR 1.01 [1 – 1.019], p = 0.046) respectively. Conclusions: Left atrial ablation complication and readmission rates were similar between SD and ND discharge practices. Hypertension and procedural duration were associated with increased complication rates irrespective of discharge strategy. These data, which represent the first side-by-side comparison of discharge strategy, suggests same-day discharge is safe and feasible for left atrial ablation procedures.