Safety and cost-effectiveness of same-day complex left atrial ablation. (1st January 2021)

• Record Type: Journal Article
• Authors: He, Hejie; Datla, Sushma; Weight, Nicholas; Raza, Sidra; Lachlan, Thomas; Aldhoon, Bashar; Panikker, Sandeep; Dhanjal, Tarv; Yusuf, Shamil; Foster, William; Hayat, Sajad; Osman, Faizel
• Is Part Of: International journal of cardiology. Volume 322(2021)
• Page Start: 170
• Page End: 174
• Publication Date: 2021-01-01
• Subjects: Atrial fibrillation ablation -- Cryo-ablation -- 3D mapping/ablation -- Same-day procedures -- Safety -- Cost-efficacy; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2020.09.066
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Catheter ablation for complex left-atrial arrhythmia is increasing worldwide with many centres admitting patients overnight. Same-day procedures using conscious sedation carry significant benefits to patients/healthcare providers but data are limited. We evaluated the safety and cost-effectiveness of same-day complex left-atrial arrhythmia ablation. Method: Multi-centre retrospective cohort study of all consecutive complex elective left-atrial ablation procedures performed between January 2011 and December 2019. Data were collected on planned same-day discharge versus overnight stay, baseline parameters, procedure details/success, ablation technology, post-operative complications, unplanned overnight admissions/outcomes at 4-months and mortality up to April 2020. A cost analysis of potential savings was also performed. Results: A total of 967 consecutive patients underwent complex left-ablation using radiofrequency (point-by-point ablation aided by 3D-mapping or PVAC catheter ablation with fluoroscopic screening) or cryoballoon-ablation (mean age: 60.9 ± 11.6 years, range 23-83 yrs., 572 [59%] females). The majority of patients had isolation of pulmonary veins alone ( n = 846, 87%) and most using conscious-sedation alone ( n = 921, 95%). Of the total cohort, 414 (43%) had planned same-day procedure with 35 (8%) admitted overnight due to major ( n = 5) or minor ( n = 30) complications. Overall acute procedural success-rate was 96% ( n = 932). Complications in planned overnight-stay/same-day cohorts were low. At 4-month follow-up there were 62 (6.4%) readmissions (femoral haematomas, palpitation, other reasons); there were 3 deaths at mean follow-up of 42.0 ± 27.6 months, none related to the procedure. Overnight stay costs £350; the same-day ablation policy over this period would have saved £310, 450. Conclusions: Same-day complex left-atrial catheter ablation using conscious sedation is safe and cost-effective with significant benefits for patients and healthcare providers. This is especially important in the current financial climate and Covid-19 pandemic. Highlights: We have previously reported same-day standard catheter ablation is safe, feasible and cost-effective. Data on same-day complex left-atrial ablation are limited. Our multi-centre cohort study of 967 consecutive elective complex left-atrial ablation procedures between January 2011 and December 2019 revealed same-day ablations using conscious sedation were safe and associated with very few complications and could have significant benefits to patients and cost-savings for healthcare providers worldwide. Same-day complex left-atrial ablation procedures can be performed safely without the need for overnight-stay. This has major implications for both patients and healthcare providers, especially given the current financial challenges and Covid-19 pandemic.