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Updated: Nov 14, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Barriers and financial impact of same-day discharge after atrial fibrillation ablation
Edward Chu1, Chi Zhang1, Daniel R Musikantow1
1Helmsley Electrophysiology Center, Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Insights
Same-day discharge after atrial fibrillation (AF) ablation is feasible for up to 80% of patients. Addressing logistical barriers could save approximately $1.5 million annually through reduced hospital costs.
Area of Science:
- Cardiology
- Health Economics
Background:
- Same-day discharge (SDD) is increasingly considered for atrial fibrillation (AF) ablation.
- This study investigates barriers and financial implications of SDD in elective AF ablation patients.
Purpose of the Study:
- To evaluate the proportion of patients eligible for SDD after AF ablation.
- To identify barriers preventing SDD.
- To assess the financial impact of implementing SDD.
Main Methods:
- Retrospective review of 249 outpatient AF ablations performed in 2019.
- Defined SDD barriers as interventions preventing discharge by 8 p.m.
- Calculated financial impact based on avoided overnight stays and potential revenue from chest pain management.
Main Results:
- 63% of patients could have been discharged same-day without management changes; up to 80% with addressed barriers.
- Barriers included logistics (43%), prolonged recovery (42%), and minor complications (15%).
- Factors associated with barriers: increasing age, LVEF ≤ 35%, and left atrial dilation.
Conclusions:
- Up to 80% of patients are candidates for SDD if avoidable delays are managed.
- SDD could yield financial savings of approximately $1.5 million annually.
- Savings stem from reduced hospital operating expenses and increased revenue opportunities.
Background:
Same-day discharge (SDD) after atrial fibrillation (AF) ablation is increasingly being considered. This study examined the barriers and financial impact associated with SDD in a contemporary cohort of patients undergoing elective AF ablation.
Methods:
A single center retrospective review was conducted of the 249 first case-of-the-day outpatient AF ablations performed in 2019 to evaluate the proportion of patients that could have undergone SDD. Barriers to SDD were defined as any intervention that prevented SDD by 8 p.m. The financial impact of SDD was based on savings from avoidance of the overnight hospital stay and revenue related to management of chest pain facilitated by a vacant hospital bed.
Results:
SDD could have occurred in 157 patients (63%) without change in management and in up to 200 patients (80%) if avoidable barriers were addressed. Barriers to SDD included non-clinical logistical issues (43%), prolonged post-procedure recovery (42%) and minor procedural complications (15%). On multivariate analysis, factors associated with barriers to SDD included increasing age (P = .01), left ventricular ejection fraction ≤ 35% (P = .04), and severely dilated left atrium (P = .04). The financial gain from SDD would have ranged from $1,110,096 (assuming discharge of 63% of eligible patients) to $1,480,128 (assuming 80% discharge) over the course of a year.
Conclusions:
Up to 80% of patients undergoing outpatient AF ablation were amenable to SDD if avoidable delays in care had been anticipated. Based on reduced hospital operating expenses and increased revenue from management of individuals with chest pain, this would translate to a financial savings of ∼$1.5 million.
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