Author + information
- Received December 12, 2019
- Revision received January 21, 2020
- Accepted February 13, 2020
- Published online April 29, 2020.
- Marc W. Deyell, MD, MSca,∗ (, )
- Richard A. Leather, MDb,
- Laurent Macle, MDc,
- Jacqueline Forman, RN, MSNd,
- Paul Khairy, MD, PhDc,
- Ruth Zhang, MSce,
- Lillian Ding, MSce,
- Santabhanu Chakrabarti, MDa,
- John A. Yeung-Lai-Wah, MBChBa,
- Christopher Lane, MDb,
- Paul G. Novak, MDb,
- Laurence D. Sterns, MDb,
- Matthew T. Bennett, MDa,
- Zachary W. Laksman, MD, MSca,
- Markus B. Sikkel, MBBSb and
- Jason G. Andrade, MDa
- aHeart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
- bDivision of Cardiology, Royal Jubilee Hospital, Victoria, British Columbia, Canada
- cMontreal Heart Institute, Université de Montréal, Montréal, Quebec, Canada
- dSt. Paul’s Hospital, Vancouver, British Columbia, Canada
- eCardiac Services British Columbia, Vancouver, British Columbia, Canada
- ↵∗Address for correspondence:
Dr. Marc W. Deyell, Heart Rhythm Services, St. Paul’s Hospital, #211 – 1033 Davie Street, Vancouver, BC, V6E 1M7, Canada.
Objectives The purpose of this study was to evaluate the efficacy, health care utilization, and safety of a same-day discharge protocol.
Background Catheter ablation of atrial fibrillation (AF) is the most common ablation performed. Increasing volumes of AF ablation are placing demands on hospital resources. In response, our institutions developed a same-day discharge protocol for AF ablation.
Methods This was a multicenter cohort study of all patients undergoing AF ablation from 2010 to 2014 at 2 major centers. The primary efficacy outcome was the proportion of successful same-day discharges. The primary health care utilization outcome was 30-day hospital readmission for any reason. The primary safety outcome was a composite of 30-day death, stroke/transient ischemic attack or embolism, or bleeding requiring hospitalization.
Results A total of 3,054 patients underwent AF ablation from 2010 to 2014 and met inclusion criteria. Same-day discharge was achieved in 79.2% (2,418 of 3,054). Hospital readmission at 30 days was 7.7% for the same-day discharge group, 10.2% for those who remained in the hospital overnight without complications (p = 0.055 for comparison with same-day discharge), and 19.5% (p < 0.001) for those who remained in the hospital with procedural complications (7.7%). Complication rates from discharge to 30 days (excluding immediate procedural complications) were 0.37% for the same-day discharge group, 0.36% (p = 0.999) for those kept overnight without complications, and 2.5% (p = 0.044) for those with initial procedural complications.
Conclusions Same-day discharge after AF ablation is feasible in the majority of patients with use of a standardized protocol. This approach was not associated with higher hospital readmission or complication rates after discharge.
This work was supported the Canadian Cardiovascular Society. Drs. Deyell and Andrade were supported by Career Scholar awards from the Michael Smith Foundation for Health Research (5967, 5963). Dr. Deyell has received research funding and honoraria from Biosense Webster and research funding from Bayer. Dr. Laksman has received research funding from Abbott. Dr. Sikkel has received a lecture honorarium from Biosense-Webster. Dr. Andrade has received research funding and honoraria from Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received December 12, 2019.
- Revision received January 21, 2020.
- Accepted February 13, 2020.
- 2020 American College of Cardiology Foundation
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