Efficacy and Safety of Same-Day Discharge for Atrial Fibrillation Ablation

Abstract

The purpose of this study was to evaluate the efficacy, health care utilization, and safety of a same-day discharge protocol. Catheter ablation of atrial fibrillation (AF) is the most common ablation performed. Increasing volumes of AF ablation are placing demands on hospital resources. In response, our institutions developed a same-day discharge protocol for AF ablation. This was a multicenter cohort study of all patients undergoing AF ablation from 2010 to 2014 at 2 major centers. The primary efficacy outcome was the proportion of successful same-day discharges. The primary health care utilization outcome was 30-day hospital readmission for any reason. The primary safety outcome was a composite of 30-day death, stroke/transient ischemic attack or embolism, or bleeding requiring hospitalization. A total of 3,054 patients underwent AF ablation from 2010 to 2014 and met inclusion criteria. Same-day discharge was achieved in 79.2% (2,418 of 3,054). Hospital readmission at 30days was 7.7% for the same-day discharge group, 10.2% for those who remained in the hospital overnight without complications (p=0.055 for comparison with same-day discharge), and 19.5% (p<0.001) for those who remained in the hospital with procedural complications (7.7%). Complication rates from discharge to 30days (excluding immediate procedural complications) were 0.37% for the same-day discharge group, 0.36% (p=0.999) for those kept overnight without complications, and 2.5% (p=0.044) for those with initial procedural complications. Same-day discharge after AF ablation is feasible in the majority of patients with use of a standardized protocol. This approach was not associated with higher hospital readmission or complication rates after discharge.