Background: Cardiac centres are facing increasing demand for elective AF ablation, which has conventionally required overnight admission due to potential procedural complications. Routine care has included trans-thoracic echocardiography (TTE) one day after ablation to exclude procedure-related pericardial effusion prior to discharge. Local audit suggested this did not detect significant new effusion compared to on table TTE at the end of procedure. The safety and feasibility of same-day discharge after AF ablation has recently been reported in a small number of UK centres.
Purpose: To evaluate the safety and feasibility of same-day discharge in patients undergoing AF ablation, in addition to any associated cost saving.
Methods: A retrospective analysis was performed of all patients undergoing atrial fibrillation ablation from November 2017 until January 2020. During this period, patients underwent same-day discharge if procedure finished before 15:00, there were no procedural complications, on table TTE excluded the presence of a new pericardial effusion and there was no vascular access site complication after 4 hours.
Results: 191 cases were identified. Complete pulmonary vein isolation was achieved in 177 of 191 cases. Five cases were abandoned due to difficult trans-septal puncture and all returned for successful procedures under general anaesthetic (GA). Procedure time was less in patients undergoing cryo-ablation (126 and 134 minutes for local anaesthetic and GA respectively) than those undergoing radiofrequency ablation (242 minutes, all GA). Same-day discharge rates were correspondingly higher for patients undergoing cryo-ablation (70%) than radiofrequency ablation (49%). Same-day discharge was achieved in 114 of 191 cases (60%). Three patients (1.6%) were found to have a new pericardial effusion during or at the end of procedure (two cryo-ablation, one radiofrequency ablation). Two effusions were small and conservatively managed, one developed cardiac tamponade requiring pericardiocentesis. Of 114 patients who underwent same-day discharge, no patient subsequently developed symptomatic pericardial effusion. One patient required procedure-related re-admission (0.9%), due to pericarditic pain after four days and was discharged within 24 hours. No patient undergoing same-day discharge experienced a complication that would have been identified during an overnight stay. Based on an average local cost of £300 for an overnight admission, 114 patients who underwent same-day discharge was associated with a £34,200 cost saving.
Conclusion: In a single centre cohort of patients undergoing AF ablation, same-day discharge was safe with no evidence that overnight stay prevents readmission due to procedural complications, or that clinically significant pericardial effusion develops following on table TTE. Same-day discharge is technically feasible in a majority of patients and is associated with a bed occupancy reduction and cost saving.