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Same-Day Discharge After Catheter Ablation of Atrial Fibrillation in the United States
Amneet Sandhu1,2, Li Qin3, Karl Minges3
1Division of Cardiology, Section of Electrophysiology University of Colorado Denver CO USA.
Insights
Same-day discharge (SDD) after atrial fibrillation (AF) ablation increased significantly from 0.99% to 62.3% between 2016 and 2023. SDD is associated with low complication rates, comparable to overnight hospitalization.
Area of Science:
- Cardiology
- Medical Procedures
- Public Health
Background:
- Historically, patients undergoing atrial fibrillation (AF) ablation required overnight hospitalization.
- National rates for same-day discharge (SDD) following AF ablation were previously unknown.
Purpose of the Study:
- To determine the national rates of SDD after AF ablation.
- To analyze factors associated with SDD and compare complication rates.
Main Methods:
- Utilized the NCDR AF Ablation Registry (January 2016 - June 2023).
- Stratified 139,391 patients by postprocedure disposition: SDD, overnight, or >1 day hospitalization.
- Analyzed rates, clinical factors, and hospital variation for SDD.
Main Results:
- SDD rates increased from 0.99% to 62.3% (P<0.0001), surpassing overnight hospitalization by Q1 2021.
- SDD likelihood increased significantly over time (OR, 1.26 per quarter-year).
- Major complication rates were 0.03% for SDD vs. 0.24% for overnight hospitalization.
Conclusions:
- SDD following AF ablation has markedly increased, coinciding with the COVID-19 pandemic.
- SDD patients had fewer comorbidities and lower rates of persistent AF.
- Postprocedural complication rates for SDD were low and comparable to overnight hospitalization.
Background:
Patients undergoing atrial fibrillation (AF) ablation have historically been hospitalized overnight or longer postprocedure. National rates of same-day discharge (SDD) following AF ablation remain unknown.
Methods And Results:
The NCDR (National Cardiovascular Data Registry) AF Ablation Registry was used to identify index procedures from January 1, 2016 to June 30, 2023. Patients were stratified by postprocedure disposition: (1) SDD, (2) overnight hospitalization (<1 day), or (3) >1 day hospitalization. Rates, clinical factors, and hospital-level variation associated with SDD were analyzed. Among 139 391 patients who underwent AF ablation across 197 hospitals, 51 622 (37.0%) underwent SDD, 78 220 (56.1%) were hospitalized overnight, and 9549 (6.9%) for >1 day postprocedure. SDD rates increased from 0.99% in Q1 2016 to 62.3% in Q2 2023 (P<0.0001), surpassing overnight hospitalization in Q1 of 2021. The likelihood of SDD increased significantly over time (odds ratio [OR], 1.26 per quarter-year [95% CI, 1.26-1.26]) with substantial variation across hospitals (median OR, 4.12 [95% CI, 3.48-4.79]). Those discharged the same day were less likely of Black race (OR, 0.71 [95% CI, 0.65-0.78]) and to have persistent AF (OR, 0.85 [95% CI, 0.82-0.88]) and cardiomyopathy (OR, 0.87 [95% CI, 0.84-0.91]). In total, major and overall complication rates were 0.70% and 2.13%, respectively. Major and overall complication rates were 0.03% and 0.19% for SDD and 0.24% and 0.98%, respectively, for overnight hospitalization.
Conclusions:
Rates of SDD following AF ablation markedly increased over time, corresponding with onset of the COVID-19 pandemic, with substantial hospital variation. SDD patients had fewer comorbid conditions and were less likely to have persistent AF. Postprocedural complication rates with SDD were low and comparable with patients hospitalized overnight.
