Same-Day Catheter Ablation Is Safe and Cost-Effective
Can catheter ablation be performed safely on an outpatient basis?
This was a retrospective review of 897 patients (mean age 56 years) who underwent outpatient radiofrequency catheter ablation (RFCA) of typical atrial flutter, atrioventricular nodal reentrant tachycardia, atrial tachycardia, an accessory pathway, the atrioventricular node, or ventricular ectopy arising in the right ventricular outflow tract. Echocardiography was performed post-procedure and the patients were observed for 3-4 hours before discharge. The same-day discharge was cancelled in the event of a complication or need for transeptal catheterization.
The mean procedure duration was 91 minutes and the acute ablation success rate was 96%. No patient had a post-ablation pericardial effusion. An unplanned admission occurred in 92 patients, most commonly because of transeptal catheterization (50 patients) or a complication (19 patients). The complications consisted of atrioventricular block, femoral site bleeding, hypotension requiring intravenous fluids or reversal of sedation, or pulmonary edema and always became manifest within 2 hours of the procedure. Among all patients with a same-day discharge, none had a subsequent complication that would have been detected had they remained in the hospital overnight. Avoidance of an overnight stay resulted in an estimated cost savings of $365,000 for the patients in this study.
Catheter ablation procedures that do not require transeptal catheterization can be performed safely on an outpatient basis, thereby reducing cost.
This study provides contemporary confirmation of studies published more than 20 years ago demonstrating the safety and cost savings of outpatient catheter ablation. However, the results do not apply to ablation of complex arrhythmias such as atrial fibrillation or ventricular tachycardia in patients with structural heart disease.
Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Pericardial Disease, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Echocardiography/Ultrasound
Keywords: Accessory Atrioventricular Bundle, Arrhythmias, Cardiac, Atrial Flutter, Atrioventricular Block, Atrioventricular Node, Bundle of His, Cardiac Catheterization, Catheter Ablation, Cost Savings, Echocardiography, Hypotension, Pericardial Effusion, Pulmonary Edema, Tachycardia, Atrioventricular Nodal Reentry, Ventricular Premature Complexes
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