Dataset Information

Safety and cost-effectiveness of same-day complex left atrial ablation.

ABSTRACT:

Background

Catheter ablation for complex left-atrial arrhythmia is increasing worldwide with many centres admitting patients overnight. Same-day procedures using conscious sedation carry significant benefits to patients/healthcare providers but data are limited. We evaluated the safety and cost-effectiveness of same-day complex left-atrial arrhythmia ablation.

Method

Multi-centre retrospective cohort study of all consecutive complex elective left-atrial ablation procedures performed between January 2011 and December 2019. Data were collected on planned same-day discharge versus overnight stay, baseline parameters, procedure details/success, ablation technology, post-operative complications, unplanned overnight admissions/outcomes at 4-months and mortality up to April 2020. A cost analysis of potential savings was also performed.

Results

A total of 967 consecutive patients underwent complex left-ablation using radiofrequency (point-by-point ablation aided by 3D-mapping or PVAC catheter ablation with fluoroscopic screening) or cryoballoon-ablation (mean age: 60.9 ± 11.6 years, range 23-83 yrs., 572 [59%] females). The majority of patients had isolation of pulmonary veins alone (n = 846, 87%) and most using conscious-sedation alone (n = 921, 95%). Of the total cohort, 414 (43%) had planned same-day procedure with 35 (8%) admitted overnight due to major (n = 5) or minor (n = 30) complications. Overall acute procedural success-rate was 96% (n = 932). Complications in planned overnight-stay/same-day cohorts were low. At 4-month follow-up there were 62 (6.4%) readmissions (femoral haematomas, palpitation, other reasons); there were 3 deaths at mean follow-up of 42.0 ± 27.6 months, none related to the procedure. Overnight stay costs £350; the same-day ablation policy over this period would have saved £310,450.

Conclusions

Same-day complex left-atrial catheter ablation using conscious sedation is safe and cost-effective with significant benefits for patients and healthcare providers. This is especially important in the current financial climate and Covid-19 pandemic.

SUBMITTER: He H

PROVIDER: S-EPMC7521347 | biostudies-literature | 2021 Jan

REPOSITORIES: biostudies-literature

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Publications

Safety and cost-effectiveness of same-day complex left atrial ablation.

He Hejie H Datla Sushma S Weight Nicholas N Raza Sidra S Lachlan Thomas T Aldhoon Bashar B Panikker Sandeep S Dhanjal Tarv T Yusuf Shamil S Foster William W Hayat Sajad S Osman Faizel F

International journal of cardiology 20200928

<h4>Background</h4>Catheter ablation for complex left-atrial arrhythmia is increasing worldwide with many centres admitting patients overnight. Same-day procedures using conscious sedation carry significant benefits to patients/healthcare providers but data are limited. We evaluated the safety and cost-effectiveness of same-day complex left-atrial arrhythmia ablation.<h4>Method</h4>Multi-centre retrospective cohort study of all consecutive complex elective left-atrial ablation procedures perform ...[more]

PMID: 33002522

Similar Datasets

Project description:BackgroundCircumferential pulmonary vein isolation (CPVI) has a high recurrence rate in managing persistent atrial fibrillation (AF). While some studies suggest that augmenting CPVI with additional left atrial BOX ablation can diminish this recurrence rate among patients with persistent AF, this approach remains controversial. This meta-analysis assesses the safety and efficacy of adjunctive left atrial BOX ablation in treating persistent atrial fibrillation.MethodsWe conducted a comprehensive literature search across China National Knowledge Infrastructure (CNKI), PubMed, Web of Science, and Cochrane Library, focusing on randomized controlled trials. The primary outcome was the recurrence rate of any atrial arrhythmias (AAs) within one-year post-treatment, with the secondary outcome being the frequency of adverse events related to the surgery.ResultsThe combination of CPVI and left atrial BOX ablation did not lead to a significant reduction in the overall recurrence rate of atrial arrhythmias (risk ratios (RR) = 0.86, 95% confidence interval (CI) = 0.73-1.02, I2 = 35%). However, subgroup analyses revealed that this therapeutic approach significantly decreased the recurrence rates of all atrial arrhythmias (RR = 0.67, 95% CI = 0.49-0.92, I2 = 15%) and specifically atrial fibrillation (RR = 0.53, 95% CI = 0.37-0.77, I2 = 0%) in patients with a left atrial diameter ≤44 mm. Notably, there was no significant increase in the incidence of procedure-related adverse events (RR = 1.04, 95% CI = 0.56-1.94, I2 = 0%). However, the durations of both the ablation (mean difference (MD) = 19.77, 95% CI = 15.84-23.70, I2 = 0%) and the overall procedure (MD = 15.64, 95% CI = 6.99-24.29, I2 = 0%) were longer due to the additional ablation steps.ConclusionsIn patients with smaller left atrial diameters, augmenting CPVI with left atrial BOX ablation significantly lowers the recurrence rates of atrial arrhythmias and atrial fibrillation without elevating surgical risk levels.

Dataset Information

Safety and cost-effectiveness of same-day complex left atrial ablation.

Background

Method

Results

Conclusions

Publications

Safety and cost-effectiveness of same-day complex left atrial ablation.

Similar Datasets

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