Safety and cost-effectiveness of same-day complex left atrial ablation

INTERNATIONAL JOURNAL OF CARDIOLOGY

卷:322

Article

He, Hejie^1,4  Datla, Sushma¹  Weight, Nicholas¹  Raza, Sidra¹  Lachlan, Thomas^1,4  Aldhoon, Bashar²  Panikker, Sandeep¹  Dhanjal, Tarv^1,4  Yusuf, Shamil¹  Foster, William²  Hayat, Sajad^1,3  Osman, Faizel^1,4 

[1] Univ Hosp Coventry & Warwickshire NHS Trust, Dept Cardiol, Clifford Bridge Rd, Coventry CV2 2DX, W Midlands, England

[2] Worcester Royal Hosp, Dept Cardiol, Charles Hastings Way, Worcester WR5 1DD, England

[3] Hamad Med Corp, Dept Adult Cardiol Heart Hosp, Doha, Qatar

[4] Univ Warwick, Warwick Med Sch, Gibbet Hill Rd, Coventry CV4 7HL, W Midlands, England

关键词: Atrial fibrillation ablation;    Cryo-ablation;    3D mapping/ablation;    Same-day procedures;    Safety;    Cost-efficacy;   

DOI  :  10.1016/j.ijcard.2020.09.066

来源: Elsevier

【 摘 要 】

Background: Catheter ablation for complex left-atrial arrhythmia is increasing worldwide with many centres admitting patients overnight. Same-day procedures using conscious sedation carry significant benefits to patients/healthcare providers but data are limited. We evaluated the safety and cost-effectiveness of same-day complex left-atrial arrhythmia ablation. Method: Multi-centre retrospective cohort study of all consecutive complex elective left-atrial ablation procedures performed between January 2011 and December 2019. Data were collected on planned same-day discharge versus overnight stay, baseline parameters, procedure details/success, ablation technology, postoperative complications, unplanned overnight admissions/outcomes at 4-months and mortality up to April 2020. A cost analysis of potential savings was also performed. Results: A total of 967 consecutive patients underwent complex left-ablation using radiofrequency (point-by point ablation aided by 3D-mapping or PVAC catheter ablation with fluoroscopic screening) or cryoballoonablation (mean age: 60.9 +/- 11.6 years, range 23-83 yrs., 572 [59%] females). The majority of patients had isolation of pulmonary veins alone (n = 846, 87%) and most using conscious-sedation alone (n = 921, 95%). Of the total cohort, 414 (43%) had planned same-day procedure with 35 (8%) admitted overnight due to major (n = 5) or minor (n = 30) complications. Overall acute procedural success-rate was 96% (n = 932). Complications in planned overnight-stay/same-day cohorts were low. At 4-month follow-up there were 62 (6.4%) readmissions (femoral haematomas, palpitation, other reasons); there were 3 deaths at mean follow-up of 42.0 +/- 27.6 months, none related to the procedure. Overnight stay costs 350; pound the same-day ablation policy over this period would have saved 310,450 pound. Conclusions: Same-day complex left-atrial catheter ablation using conscious sedation is safe and cost-effective with significant benefits for patients and healthcare providers. This is especially important in the current financial climate and Covid-19 pandemic. (C) 2020 Elsevier B.V. All rights reserved.

【 授权许可】

Free