Safety and implementation of day case pulmonary vein isolation following introduction of a same-day discharge protocol - a retrospective cohort audit
A Barry, R M Evans, S Byrne, R Sheahan, Z SharifAbstract
Background
Same-day discharge (SDD) has been increasingly adopted as a means of optimising resource utilisation. Catheter ablation has historically been performed as an overnight inpatient procedure, posing multiple limitations, namely bed occupancy pressures/costs, and delayed discharge despite low complication rates. EHRA's latest consensus statement on catheter ablation for atrial fibrillation (AF) emphasises the benefits of SDD (1), with multiple studies showing SDD is safe in low-risk patients. We introduced a SDD protocol for our AF care cohort in 2024. This review assesses that protocol, in a study population composed of the largest SDD public pulmonary vein isolation (PVI) cohort in Ireland.
Purpose
Our review aimed to assess the safety and feasibility of a SDD protocol implemented by our group in 2024-25. We hypothesised that overnight admissions following catheter ablation offer no additional safety benefits and SDD was feasible in selected eligible patients. We aimed to expand and refine a safe and efficient patient-centred day-case AF ablation pathway at our centres.
Methods
Data was collected retrospectively on consecutive patients admitted for elective PVI, including those eligible and ineligible for SDD. Eligible patients included those with an uncomplicated procedure, stable haemodynamic profile, controlled access haemostasis, case finished before set time, and adequate social support and proximity to the hospital. Data was collected through review of the hospital's electronic medical records. Outcomes assessed included complication rates, rates of early GP and ED presentation, and rates of readmission in the first 30 days following procedure for both the eligible and ineligible groups.
Results
A total of 72 PVI cases were audited. Mean age was 62.27. 55 were male and 17 were female. Within the cohort, 53% were eligible for SDD. Complication rates are 8% in the eligible group and 6% in the ineligible group. 3% of eligible patients presented to their GP in the follow up period, compared to 6% in the ineligible group. Rates of representation to ED and readmission were 5% and 0% in the eligible group, and 12% and 9% in the ineligible group, respectively. Representations, 9/72 (12%), were due to cardiac symptoms or events (4), femoral access site complications (3), and non-cardiac causes (2).
Conclusion
Our outcome data supports safety and feasibility of our SDD protocol and is in line with complication and readmission rates in larger scale studies. Areas for further investigation include work to expand inclusion criteria and assess outcomes across various closure devices and anaesthetic techniques. The protocol's broader implementation will free beds for acute cases, reduce costs, and increase procedural throughput.Patient groups and outcome data