Abstract 12449: Clinical Impact of Reducing Bedrest After Pulmonary Vein Isolation

Abstract

Background: Following pulmonary vein isolation (PVI), patients are typically prescribed 6 hours of bedrest to minimize bleeding. To streamline post-procedural care, our institution recently switched to a reduced bedrest period of 3 hours. Objective: To determine if reduced bedrest after PVI results in increased bleeding. Methods: We prospectively examined rates of bleeding, length of hospital stay, and urinary catheterization among patients undergoing PVI at our institution from April-May 2021. We compared these metrics to patients who underwent PVI with 6-hour bedrest in April-May 2019, predating our institutional protocol change. Figure-of-8 (FO8) sutures were used to achieve hemostasis in all patients. Continuous and categorical variables were compared using Student’s t-test and Fisher’s exact test, respectively. Results: Bilateral access was more common and procedure times were slightly longer in the 6-hour cohort; other baseline characteristics were similar between groups (Table 1). There was 1 major vascular access site complication (a retroperitoneal bleed) in the 6-hour and none in the 3-hour cohort. Minor bleeding occurred in 11% of each group. Same-day discharge was achieved in 42/45 (93%) of the 3-hour and 4/55 (7%) of the 6-hour group (p<0.001). Nine of 45 patients (20%) in the 3-hour group required urinary catheterization compared with 33/55 (60%) in the 6-hour group (p<0.001). Catheter-associated urinary tract infections (2% vs. 4%) and opioid analgesia use (22% vs. 36%) were lower in the 3- vs. 6-hour cohort, but these differences were not statistically significant. Conclusion: These data suggest that reducing post-PVI bedrest from 6 to 3 hours decreases length of hospital stay and urinary catheterization rates without increasing the risk of bleeding or vascular access site complications. Use of FO8 sutures, enhanced procedural efficiency and a shift toward unilateral femoral access may have contributed to the safety of this protocol change.