Safety of a very short discharge program for cardiac catheter ablation
L Fernandez Ruz, J Gonzalez Lozano, M Alcala Ramirez Del Puerto, C Ceballos Gomez, A Burgos-Martin, J A Vega Ruiz, M A Bravo Pulido, G Ballesteros DerbentiAbstract
Introduction and Purpose
Catheter ablation (CA) is the first option in arrhythmias refractory to pharmacological treatment and is becoming the first-line treatment for an increasing number of patients. Due to the need to reduce hospitalization-related costs, same day discharge (SDD) protocols are emerging in cardiac electrophysiology (EP). The purpose of this prospective, observational, single-center study is to assess the safety of a very short (2-to-4 hour) discharge program after CA procedures with utilization of suture-based vascular closure devices (VCD).
Methods
From October 2023 to May 2025 we included 214 patients admitted for a programmed cardiac CA procedure. All patients had venous vascular access haemostasis with a suture-based VCD. If transseptal puncture (TSP) was performed, standard TTE was issued before discharge. All procedures were performed with uninterrupted anticoagulation (if needed). Oral tolerance was initiated in the first hour (no or light sedation) or after 2 hours (deep sedation). The same specialized EP nurse that assisted the EP/CA was in charge of the observation room. The next day, EP nurse contacted each patient via telephone, assessed possible complications or issued a physical consultation. We analyzed the rate of vascular and non-vascular complications at 30-days of follow-up based on telephone monitoring and medical electronic registries.
Results
Mean age of 59.19 years (+/- 15.8), with 54,2% female. The vast majority (175/214, 81.8%), had double femoral vein access. Only one patient had femoral artery access. In 36 patients a figure-of-8 suture was added to the suture-based VCD. No manual compression was performed. 46.7% of patients were under anticoagulation therapy (100/214). The type of procedure was: EP study (40/214, 18.7%), supraventricular tachycardia (SVT) ablation (60/214, 28%), atrial fibrillation (AF) ablation (44/214, 20.5%), typical and atypical atrial flutter (56/214, 26,2%), atrial tachycardia (4/214, 1,8%), atrioventricular node ablation (7/214, 3,3%) and ventricular extrasystole ablation (3/214, 1,4%). TSP was performed in 52 patients (24,3%). Mean admission time was 146.8 minutes (97.86 minutes for SVT/EP and 236.4 minutes for AF ablation). No major complications were found before discharge and at first telephone consultation nor 30-day follow-up. 8 patients (3.7%) had superficial hematoma; all resolved spontaneously. 9 patients (4.2%) referred pain at the vascular access, resolved with basic analgesia. No readmissions at 30 days were found. In 15 patients (7%), EP nurses issued a presential consultation, without treatment change in any of them. A high rate of satisfaction was noted within patients, but no questionnaires were issued before discharge
Conclusion
A very short discharge program for catheter CA with a suture-based VCD is a safe option, without an increase of complications, achieving a great reduction in hospitalization costs and an increase in comfort in our patients.