Feasibility and Safety of Same-Day Home Discharge After Radiofrequency Catheter Ablation
Résumé
Interventional cardiology in a day-case setting might reduce logistic constraints on hospital resources. However, in contrast with coronary angioplasty, few data support the feasibility and safety of radiofrequency catheter ablation (RCA). The aim of this prospective, multicenter cohort study was to evaluate the feasibility and safety of RCA in 1,342 patients (814 men; mean age 57 ± 17 years) considered eligible for ambulatory RCA, according to specific set of criteria, for common atrial flutter (n = 632), atrioventricular nodal reentrant tachycardia (n = 436), accessory pathways (n = 202), and atrial tachycardia (n = 72). Patients suitable for early discharge (4 to 6 hours after uncomplicated RCA) were scheduled for 1-month follow-up. Predictive factors for delayed complications were studied by multivariate analysis. Of the 1,342 enrolled patients, 1,270 (94.6%) were discharged the same day and followed for 1 month; no deaths occurred, and the readmission rate was 0.79% (95% confidence interval 0.30% to 1.27%). Six patients had significant puncture complications, 2 presented with symptomatic delayed pulmonary embolism, and 2 had new onset of poorly tolerated atrial flutter. None of these complications was life threatening. Multivariate analysis did not identify any significant independent predictors for delayed complications. In conclusion, these data suggest that same-day discharge after uncomplicated RCA for routine supraventricular arrhythmias is safe and may be applicable in clinical practice. This approach is known to be associated with significant patient satisfaction and cost savings and can be considered a first-line option in most patients who undergo routine ablation procedures. © 2009 Elsevier Inc. All rights reserved.
Mots clés
adult
aged
ambulatory care
arteriovenous fistula
article
atrioventricular junction arrhythmia
blood analysis
blood transfusion
catheter ablation
clinical evaluation
clinical examination
cohort analysis
cost control
electrocardiography
false aneurysm
feasibility study
female
femoral artery
follow up
health insurance
heart arrhythmia
heart atrium flutter
hematoma
hemostasis
hospital discharge
hospital readmission
human
lung embolism
major clinical study
male
medical care
multivariate analysis
patient satisfaction
postoperative complication
priority journal
prospective study
safety
supraventricular tachycardia
surgical technique
thrombocyte count
transthoracic echocardiography
vascular surgery
Adolescent
Adult
Aged
80 and over
Ambulatory Surgical Procedures
Arrhythmias
Cardiac
Catheter Ablation
Cohort Studies
Confidence Intervals
Feasibility Studies
Female
France
Humans
Logistic Models
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Prospective Studies
Safety
Stroke Volume
Switzerland
Time Factors
Treatment Outcome
Ventricular Function
Left
Young Adult