PO-697-03 CATHETER ABLATION OF ATRIAL FIBRILLATION IN THE AMBULATORY SURGICAL CENTER DURING THE SARS-COV-2 PANDEMIC

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The scheduling of elective ablation procedures in hospitals has been significantly disrupted by the SARS-CoV-2 pandemic. Between March 2020 and December 2021, we performed approximately 500 AF ablations in our specialized heart rhythm ambulatory surgical center. Describe the clinical effectiveness and safety of symptomatic patients with Atrial Fibrillation (AF) or Atypical Atrial Flutter (AAFL) undergoing ablation in the non-hospital setting with same day discharge. All patients received general anesthesia and intubation. Intravenous Heparin was administered to maintain an ACT of > 350 sec. throughout the procedure. A TEE or intracardiac echo was performed to guide trans-septal access. Carto 3 Version 7 (Biosense Webster, CA) was used in all patients; LA mapping consisted of a PENTARAY catheter, and ablation was performed with an Irrigated STSF 8F catheter. The end-point of the procedure was pulmonary vein isolation (PVI) and absence of inducible AF or AAFL and conduction block across ablation lines. Reversal of Heparin was achieved with intravenous Protamine. The study group consists of 652 consecutive patients (83 men, mean age 72 +/- 8 years), including the first patient enrolled in 04/2020. There were 90 patients with paroxysmal AF, 535 patients with persistent AF and/or AAFL. 345 patients (53%) were undergoing their first ablation procedure. PVI was achieved in all patients. LA lines with conduction block (Roof, Mitral Isthmus and/or Septal) were performed in 550 patients (86%). Procedure duration varied between 61-247 minutes (mean 114.9). The total time in the ASC varied between 5.2-14.5 hours (mean 6.4). All except 3 patient were discharged home the same day as the procedure. Complications: 1 acute pericardial eff req. paracentesis, 2 large hematoma req. hospitalization without intervention, 1 protamine anaphylactic rxn treated prior to discharge. The overall major complication rate was <1%. Throughout the pandemic, the ASC has provided an effective outpatient setting to safely perform ablation of AF and AAFL. These findings have important implications for interventional electrophysiology, and support a shift of health care delivery of performing complex ablations in a lower cost and non-hospital setting.