Ablation is Feasible for Atrial Fibrillation in the Ambulatory Setting

Catheter ablation for atrial fibrillation (AF) in the ambulatory outpatient setting is feasible and safe, researchers reported in Heart Rhythm O².

The retrospective, observational study presented results of all AF ablation cases performed at a single ambulatory outpatient laboratory from December 1, 2016, to March 22, 2023.

Patient data were obtained from medical records and included demographics, AF history, echocardiographic data, intraprocedural and postprocedural data, complications, discharge characteristics, and emergency department (ED) records and hospitalization data in the month after the procedure.

A total of 476 patients were included. They had a mean age of 57.5±9.3 years, body mass index of 32.9±7.0, and CHA₂DS₂-Vasc score of 1.7±1.3. Of the cohort, 55% had paroxysmal AF and 45% had persistent or longstanding persistent AF. The patients received pulmonary vein isolation, and most received additional ablation beyond the pulmonary veins.

The primary outcome of a major perioperative safety event occurred in 7 patients. In addition, 4 patients had tamponade that required percutaneous drainage and 3 patients were transferred for computed tomography imaging owing to suspected bleeding. All patients were stabilized in the catheter laboratory and were transferred in stable condition to the hospital for overnight observation, and none needed surgical intervention.

The secondary safety outcome, ED incidence or use of hospital services before discharge, occurred in 7 patients. Prolonged groin care was needed in 2 patients, and 2 patients were slow to awaken after anesthesia and needed to be admitted to the ED or hospital for slow vasopressor wean.

Use of the ED postdischarge within 24 hours of the procedure was required in 7 patients for a variety of reasons, including shortness of breath (managed with fluids), groin bleeding (managed with pressure), visual changes (contact lens left in after procedure), chest pain (2 patients with no specific diagnosis, 1 treated for pericarditis), and bradycardia (spontaneously resolved). ED use from 24 hours to 7 days following ablation occurred in 34 patients, and ED use late postprocedure from 1 week to 1 month was needed in 24 patients.

Limitations of the study include the single-center, retrospective, observational design without a direct comparison with hospital-based ablation in a similar cohort. Also, the age of patients was relatively young, and they were only offered ambulatory ablation if they satisfied the physician’s judgment for safety.

“…we observed a comparable rate of complications to published hospital-based cohorts, all of which were promptly stabilized on-site,” stated the investigators. “We hope the lessons learned from this cohort guide patient safety efforts by physician groups who pursue ablation in a similar setting. We also hope to spurn a conversation between professional societies and the Centers for Medicare & Medicaid Services to expand electrophysiologic care of Medicare patients to facilities outside of hospital walls.”

Disclosure: This study was funded by an investigator-initiated grant from Medtronic, Inc. Please see the original reference for a full list of disclosures.