A recent systematic review and meta-analysis, published in the Journal of Interventional Cardiac Electrophysiology, has deemed same-day discharge following catheter ablation of atrial fibrillation (AF) to be safe and feasible.
According to a recent review, it is common practice to admit patients overnight following catheter ablation of AF, with same-day discharge common for simpler ablations such as supraventricular tachycardia. In light of this, Ali Jafry (University of Oklahoma Health Sciences Center, Oklahoma City, USA) et al set out to investigate the clinical benefits of this overnight hospital admission policy following catheter ablation of AF.
Initially, Jafry et al proposed carrying out a systematic review that would compare the safety of same-day discharge, compared to hospital admission for patients following catheter ablation for AF. However, the authors report that no randomised controlled trials met the study inclusion criteria, therefore only observational cohort studies were analysed. In order to be included in the review, the studies had to include a comparison arm including overnight hospital admission or inpatient stay longer than one day, at least one outcome of interest, and had to be published in a peer-reviewed journal.
The authors report the primary outcome to be post-discharge 30-day hospital visits, with secondary outcome measures consisting of post-discharge thromboembolic complications (stroke, transient ischaemic attack), post-discharge vascular-bleeding, post-discharge arrhythmia recurrence, 30-day mortality, and cardiac tamponade.
The majority of searches were carried out on 1 February 2021. Jafry et al note that a total of 347 studies were collected using PubMed/MEDLINE (n=160), Embase (n=123), Scopus (n=31), and Web of Science Core Collection (n=33) databases, however, only eight met the inclusion criteria. In addition, pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using the Mantel–Haenszel method for dichotomous data.
Across the included studies, patient sample numbers ranged from 41–2,406, the percentage of male patients ranged from 60–84.5%, and the mean age ranged from 57–66 years old.
Hospital visits 30days post-discharge were reported in four studies (4,466 patients). Additionally, 199 events occurred within 2,775 patients (7.1%) in the same-day discharge arm, with 114 events amongst 1,691 patients (6.7%) in the hospital admission arm. Based on the pooled estimate across the four studies, within the 30-day hospital visits, between the two arms, there was no statistical significance, with heterogeneity between the included studies (RR 0.90, 95% CI 0.40–2.02, p=0.81, p=0.81, I2=67%, p=0.03). The authors emphasise that due to low event rates, this finding should be interpreted carefully.
Post-discharge vascular/bleeding complications were reported in five studies (6,470) patients, with 18 events across 2,628 patients (0.68%) in the hospital admission arm. The pooled estimate showed no statistically significant difference between the two arms (RR 0.93, 95% CI 0.46–1.88, p=0.85; I2=0%, p<0.85).
Furthermore, three studies (5,860 patients) reported stroke/transient ischaemic attack/thromboembolic events, with five events occurring in the same-day discharge (0.13%) and the hospital admission arm (0.24%). Recurrent arrhythmia’s were reported across four studies (1,281 patients), with 52 events amongst 529 patients (9.8%) in the same-day discharge arm, and 102 events amongst 742 patients (13.7%) in the hospital admission arm.
Mortality was reported across seven studies (7,474) patients, however, there were no events in both arms of five studies and therefore could not be included in the meta-analysis. Among the same-day discharge arm, there were two events among 4,292 patients, and only one event amongst 3,192 patients in the hospital admission arm. Furthermore, cardiac tamponade was reported across six studies.
Jafry et al conclude that in carefully selected patients undergoing catheter ablation for AF, same-day discharge is feasible and safe, with no significant differences in post-discharge 30-day hospital visits, post-discharge vascular complications, as well as other outcomes included in the review. The authors note that further trials are required as the researchers did not have access to patient-level data, the analysis is prone to selection bias due to the inclusion of observational studies, and variation in the discharge used by individual studies. Lastly, the majority of studies analysed only discharged patients on the same-day if they had no major complications and adequate post-procedure observation time.