Mark D Theodoreson1, Bhaveek C Chohan1, Christopher J McAloon1, Amritpal Sandhu1, Christopher J Lancaster1, Shamil Yusuf2, William Foster3, Faizel Osman4. 1. Department of Cardiology, University Hospital Coventry/Warwick Medical School, Coventry, United Kingdom. 2. Good Hope Hospital, Birmingham, United Kingdom. 3. Worcester Royal Hospital, Worcester United Kingdom. 4. Department of Cardiology, University Hospital Coventry/Warwick Medical School, Coventry, United Kingdom. Electronic address: faizel.osman@btinternet.com.
Abstract
BACKGROUND: Catheter ablation is a curative intervention for common arrhythmias such as supraventricular tachycardia and atrial flutter. Many centers still admit patients overnight after this procedure. OBJECTIVE: This study was performed to evaluate the safety and cost-effectiveness of same-day standard catheter ablation. METHODS: We conducted a retrospective study of all consecutive elective same-day procedures performed between 2010 and 2014. Data were collected on baseline parameters, procedure details and success, postoperative complications, unplanned overnight hospital admissions, and clinical outcome (including mortality) at 4-month follow-up. A cost analysis of potential savings was also performed. RESULTS: A total of 1142 patients underwent planned same-day electrophysiological study with or without ablation. Radiofrequency ablation was performed in 897 of these patients (mean age ± standard error 56 ± 0.6 years, range 16-95 years, 467 males), with 921 arrhythmias ablated and with complete procedural success in 883 cases (96%). There were 92 unplanned admissions (10.3%): 50 for concealed pathways that required transseptal puncture, 19 for immediate complications (including 9 femoral bleeds and 5 pacemakers for heart block), 12 admitted at the operator's discretion, and 11 for other clinical reasons. All had transthoracic echocardiography after the procedure, and none had significant pericardial effusion. At 4-month follow-up, there were 16 readmissions (1 deep vein thrombosis, 3 pericarditic chest pain, 2 femoral hematomas, 7 palpitations, and 3 others) and 1 death (unrelated to ablation). An overnight stay at our center costs $450 (£300); same-day ablation over this period saved our institution $365,000 (£240,000). CONCLUSION: Same-day standard catheter ablation is safe and cost-effective, with significant benefits for patients and health care providers. This is particularly important given the current financial climate.
BACKGROUND: Catheter ablation is a curative intervention for common arrhythmias such as supraventricular tachycardia and atrial flutter. Many centers still admit patients overnight after this procedure. OBJECTIVE: This study was performed to evaluate the safety and cost-effectiveness of same-day standard catheter ablation. METHODS: We conducted a retrospective study of all consecutive elective same-day procedures performed between 2010 and 2014. Data were collected on baseline parameters, procedure details and success, postoperative complications, unplanned overnight hospital admissions, and clinical outcome (including mortality) at 4-month follow-up. A cost analysis of potential savings was also performed. RESULTS: A total of 1142 patients underwent planned same-day electrophysiological study with or without ablation. Radiofrequency ablation was performed in 897 of these patients (mean age ± standard error 56 ± 0.6 years, range 16-95 years, 467 males), with 921 arrhythmias ablated and with complete procedural success in 883 cases (96%). There were 92 unplanned admissions (10.3%): 50 for concealed pathways that required transseptal puncture, 19 for immediate complications (including 9 femoral bleeds and 5 pacemakers for heart block), 12 admitted at the operator's discretion, and 11 for other clinical reasons. All had transthoracic echocardiography after the procedure, and none had significant pericardial effusion. At 4-month follow-up, there were 16 readmissions (1 deep vein thrombosis, 3 pericarditic chest pain, 2 femoral hematomas, 7 palpitations, and 3 others) and 1 death (unrelated to ablation). An overnight stay at our center costs $450 (£300); same-day ablation over this period saved our institution $365,000 (£240,000). CONCLUSION: Same-day standard catheter ablation is safe and cost-effective, with significant benefits for patients and health care providers. This is particularly important given the current financial climate.