Same-day discharge in selected patients undergoing atrial fibrillation ablation
Same-day discharge in selected patients undergoing atrial fibrillation ablation
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DOI：
10.1111/pace.13807
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发表时间：
2019-10-13
影响因子：
1.8
通讯作者：
Gupta, Dhiraj
中科院分区：
文献类型：
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作者：
Bartoletti, Stefano;Mann, Mandeep;Gupta, Dhiraj
背景房颤（AF）消融是一个复杂的过程，通常需要至少一个晚上的住院治疗。我们调查了房颤患者在简化围消融期管理后，早期活动和当日出院的安全性和可行性。方法从2014年开始，我们为选择的患者提供当日出院，这些患者在上午的名单中接受了无并发症的房颤消融，超声引导下的股骨通道，不间断华法林或最小限度地中断新型口服抗凝剂，并在术中用鱼精蛋白逆转肝素。患者在手术后6-8小时出院，并获得专门的护士帮助热线。结果2014年4月至2017年3月1599例房颤消融患者中，811例（50.7%）在上午完成消融，169/811例（20.8%）当天出院。排除26例研究病例，1/143（0.7%）有短暂性右膈神经麻痹，5例（3.5%）有不排除当天出院的小问题；3例（2.1%）出院后需要再次住院：1例为心包胸痛，2例为恶心/呕吐。与642例过夜病例相比，日间病例的手术时间更短，更有可能是在镇静而不是全身麻醉下进行的，而且不太可能涉及线状病变和电复律。患者年龄、性别、体重指数、CHA(2)DS(2)-VASc、术前抗凝方案（华法林vs新型抗凝药物vs无抗凝药物）、消融方式选择（冷冻球囊vs射频）差异无统计学意义。结论：采用简化的围术期护理方案，房颤消融后选择当日出院是安全可行的。更广泛的采用可能会降低医疗成本，同时改善患者体验。
Background Atrial fibrillation (AF) ablation is a complex procedure, generally requiring at least one overnight hospital stay. We investigated the safety and feasibility of early mobilization and same-day discharge following streamlined peri-ablation management for AF. Methods From 2014, we offered same-day discharge to selected patients who underwent uncomplicated AF ablation on the morning lists, with ultrasound-guided femoral access, uninterrupted warfarin or minimal interruption in novel oral anticoagulants, and reversal of intraprocedural heparin with protamine. Patients were discharged 6-8 h postprocedure and offered access to a dedicated nurse helpline. Results Of 1599 AF ablation cases performed from April 2014 to March 2017, 811 (50.7%) were performed on the morning lists and 169/811 (20.8%) were discharged on the same day. Excluding 26 research cases, 1/143 (0.7%) had transient right phrenic nerve palsy and five (3.5%) cases experienced minor problems that did not preclude same-day discharge; three (2.1%) needed rehospitalization postdischarge: one for pericarditic chest pain and two for nausea/vomiting. Compared to 642 overnight cases, day-case procedures were shorter, more likely to be redos, to be performed under sedation rather than general anesthesia, and less likely to involve linear lesions and electrical cardioversion. There were no significant differences in patient age, gender, body mass index, CHA(2)DS(2)-VASc, in preprocedural anticoagulation regimen (warfarin vs novel anticoagulants vs no anticoagulation) and in choice of ablation method (cryoballoon vs radiofrequency). Conclusions Selective same-day discharge after AF ablation is safe and feasible using a streamlined peri-procedural care protocol. Wider adoption can potentially reduce health-care costs while improving patient experience.