Identification of patients who can safely undergo same day discharge following atrial fibrillation ablation: Lessons learned in the COVID-19 era

ABSTRACT

Background: Historically, pts have been admitted for overnight observation following atrial fibrillation (AF) ablation. The COVID-19 pandemic ushered the need to consider same day discharge (SDD). It remains unclear how to identify pts who can safely undergo SDD. Objective: To evaluate acute (within 4 hrs) and subacute (within 24 hrs) safety of SDD post AF ablation;we also sought to identify predictors of safe discharge. Methods: All pts undergoing AF ablation at our center following the end of the COVID imposed lockdown were enrolled. In each pt, ICE guided single transseptal puncture using the VersaCross® (Baylis) system was performed. Following ablation, protamine was not administered;all femoral venous access sites were closed with Vascade™ (Cardiva Medical) closure devices. Pts ambulated after 2 hrs of bedrest. Pts who had SDD were compared to those who stayed for overnight observation. Results: The cohort included 226 pts (65 ± 10 yrs, 157 [69%] male, 118 [52%] PAF, CHA2DS2 -VASc 2.4 ± 1.7). Cryo PVI was performed in 193 (85%) pts;34 (15%) pts had a redo procedure. SDD was attempted in 126 pts and successfully accomplished in 115 (91%) pts at 251 + 72 minutes from procedure end. The most common reason for failed SDD attempt was access site oozing necessitating additional bedrest. No SDD pt had a major complication. Overnight observation was performed in 100 (44%) pts, most commonly due to physician/pt preference. Compared to pts who had SDD, these pts were older and more likely to have heart failure and history of TIA/stroke. Oozing within the first 4 hrs was observed at a similar rate to SDD pts. A minor complication was seen in 1 pt each in SDD and overnight stay group between 4 and 24 hrs of ablation (Figure). Conclusions: Our study shows that when attempted, SDD after AF ablation can be accomplished in >90% of pts. Venous access site oozing was the greatest hinderance to pts going home. However, if pts had no issue 4 hrs after AF ablation, they had an uneventful course over the next 24 hrs. (Figure Presented).