Abstract 10427: Length of Stay After Atrial Fibrillation Ablation in a U.S. Ambulatory Surgical Setting Compared to a Hospital Setting

Abstract

Introduction: Atrial ablation for the treatment of atrial fibrillation has traditionally been performed in the hospital setting. Recently, the Centers for Medicare and Medicaid Services (CMS) announced the Hospitals Without Walls program, allowing ambulatory surgery centers (ASCs) to conduct procedures such as atrial ablations. As a result, the first cases of ablations in an ASC have recently been completed. This study aimed to compare patient length of stay (LOS) and between the ASC setting to a traditional hospital setting. Hypothesis: LOS in the ASC setting is shorter than in the traditional hospital. Methods: Data from all patients treated with cryoballoon pulmonary vein isolation (PVI) in a single ASC were analyzed. A random sample of patients treated by the same provider during the same timeframe in the hospital setting were then acquired and compared. Procedural approaches were similar, with transeptal puncture performed under intracardiac echo, contrast venography and pressure waveform analysis performed prior to ablation to ensure good venous seal. No 3D mapping was used at either site. Intraprocedural emergency protocols were established prior to ablations. Results: A total of 13 patients received treatment in the ASC, with a mean age of 71 ± 8 years, 38% female, 9 patients had paroxysmal atrial fibrillation and 4 persistent atrial fibrillation. The mean number of cryoablation applications per pulmonary vein was 1.4 ± 0.7 with average application duration of 187 ± 37 seconds. The mean procedural duration was 52 ± 10 minutes and mean time in the ASC was 5.4 ± 1.5 hours. No acute adverse events occurred; however, one patient later presented with a sore throat and a groin hematoma without active bleeding or pseudoaneurysm. A total of 13 patients were analyzed in the hospital setting. Mean time in the hospital was longer than in the ASC (13.0 ± 13.0 hours, p<0.01). This is inclusive of 2 patients staying overnight. The mean hospital length of stay was also longer than in the ASC for the 11 patients with same day discharge (8.2 ± 6.6 hours, p<0.01). Conclusions: Cryoballoon PVI performed in an ASC setting resulted in a shorter overall length of stay than in the traditional hospital setting, with no acute complications occurring.