Introduction

Percutaneous catheter ablation, especially for atrial fibrillation (AF), is a procedure performed typically in an inpatient setting. The low complication rate and efficacy of catheter ablation in hospitals suggest that it might be feasible to perform it in an outpatient setting and with same-day discharge.

Methods

Consecutive patients with symptomatic cardiac arrhythmias undergoing a percutaneous catheter ablation procedure at the Cardiance Clinic Pfäffikon (Switzerland) in an outpatient setting were included. Within two years, 192 patients (62% male; mean age 65 ± 12 years) were enrolled in this study. Baseline characteristics are shown in Table 1. All patients were admitted to the outpatient clinic in the morning of the ablation procedure, and a transesophageal echo was performed if patients were scheduled for AF ablation. Oral anticoagulation was discontinued on the day of admission. All procedures were performed in deep conscious sedation. The endpoints of the procedures were – dependent on the type of arrhythmia – termination of the tachycardia, non-inducibility, blockage of the ablation line or isolation of the pulmonary veins. The inguinal puncture side was closed via suture, or in case of atrial puncture, with an Angio-Seal™ device. After a 6-8 hour recovery and monitoring period, the patients were discharged on the same day if clinically stable. Oral anticoagulation was restarted 6 hours after the procedure. A follow-up visit was scheduled for the next day 

Results

A total of 192 catheter ablations, 62 right sided and 130 left sided procedures were performed. Specifically, ablation for AF (n=92; 89 [%] with cryoballoon), Re-PVI (n=15), AVNRT (n=25), Flutter (n=20), AT (n=24, 14 LAT), WPW (n= 6, 3 right sided AP), PVCs (n=7, 4 RVOT) and VT (n=3). See Figure 1. The median procedure time was 75 [Q1;Q3: 55; 120] min, with a median fluoroscopy dosage of 1599 ([Q1;Q3: 610; 3664) cGy.cm² and a median fluoroscopy time of 10 (Q1;Q3: 7;16) min. The mean ACT level measured during the procedures was 362 sec. The majority of patients (148/192, 77%) were anticoagulated with rivaroxaban being the most common NOAC (50%), followed by edoxaban (23%), apixaban (22%), as well as dabigatran and warfarin with 4 and 3 % each. Major complications occurred in 8 patients (4%). In 2 patients (1%) phrenic nerve palsy was observed but resolved in both patients within 12 months of follow-up. Six patients (3%) developed pericardial effusion, only 4 requiring pericardiocentesis, while one had to undergo surgery due to perforation of the left atrial appendage. Except for the latter patient, all other 121 patients (99%) were discharged on the same day after a maximum surveillance time of 8 hours. No complications occurred within 30 days after discharge.

Conclusions

Catheter ablation of all arrhythmias on the day of admission is feasible and safe with a low rate of complications. The majority of patients could be discharged on the same day without further complications within the next 30 days.