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Avoiding Bladder Catheters During Atrial Fibrillation Ablation.

Asim S Ahmed1, Brad A Clark1, Sandeep A Joshi1

  • 1St. Vincent Medical Group, St. Vincent Hospital, Indianapolis, Indiana, USA.

JACC. Clinical Electrophysiology
|February 22, 2020
PubMed
Summary

Avoiding bladder catheterization during atrial fibrillation (AF) ablation significantly reduces adverse urinary outcomes. This strategy is particularly beneficial for male patients undergoing the procedure.

Keywords:
atrial fibrillationbladder catheterhematuriapulmonary vein isolationurinary retentionurinary tract infection

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Area of Science:

  • Cardiology
  • Urology
  • Medical Device Innovation

Background:

  • Atrial fibrillation (AF) ablation is a common procedure.
  • Routine bladder catheterization during AF ablation carries potential complications.
  • The ABCD-AF study investigated the benefits of avoiding routine catheterization.

Purpose of the Study:

  • To assess the safety and efficacy of performing AF ablation without routine bladder catheterization.
  • To evaluate the impact of avoiding bladder catheters on patient-reported and clinically assessed urinary adverse events.

Main Methods:

  • A single-center, prospective, randomized controlled trial was conducted.
  • 160 patients were randomized into two groups: routine catheterization (n=80) versus as-needed catheterization (n=80).
  • The primary endpoint was a composite of cystitis, urethral injury, hematuria, dysuria, or urinary retention.

Main Results:

  • The composite primary outcome occurred significantly less often in the as-needed catheterization group (11/80) compared to the routine catheterization group (45/80; p < 0.001).
  • While not statistically significant (p=0.17), urinary tract infections were less frequent in the as-needed group (2/80 vs 7/80).
  • Urinary retention was also less frequent in the as-needed group (5/80 vs 12/80; p=0.07). Randomization to catheterization (OR 8.1) and male sex (OR 3.8) were independent predictors of the primary outcome. Subgroup analysis revealed a significantly higher risk of adverse outcomes in men randomized to catheterization (OR 14.6).

Conclusions:

  • Routine bladder catheterization can be safely omitted in patients undergoing AF ablation.
  • Avoiding routine catheterization leads to a significant reduction in adverse urinary outcomes.
  • The benefits of avoiding bladder catheterization are particularly pronounced in male patients.