Ablation of atrial fibrillation in an ambulatory outpatient setting

Journal Articles: 

BACKGROUND: The safety of atrial fibrillation (AF) ablation in an ambulatory outpatient center has not previously been reported.

OBJECTIVE: The aim of this study is to report the feasibility and safety of AF ablation in an ambulatory setting.

METHODS: We identified all AF ablations performed at the Alaska Heart and Vascular Institute’s ambulatory center since program initiation to current day using billing records. Procedural complications, postoperative utilization of hospital services, and emergency room (ER) utilization were captured by chart review.

RESULTS: A total of 476 patients underwent pulmonary vein isolation in the ambulatory setting over a 6.3-year period. Patients’ average age was 58 6 9.3 years, body mass index was 32.9 kg/m2, and the CHA2DS2-VASc (congestive heart failure, hypertension, age  75 years, diabetes mellitus, prior stroke or transient ischemic attack or thromboembolism, vascular disease, age 65–74 years, sex category) score was 1.7. For 85%, this was the first AF ablation, and 55% had paroxysmal AF. Cryoablation was used in 85%. A combined primary safety outcome capturing potentially unstable perioperative safety events occurred in 1.5% of patients, all of whom were stabilized prior to hospital transfer. A total of 1.5% of patients required same-day hospital services, with another 1.5% returning to the ER within 24 hours. A total of 96% of patients did not require hospital services within 24 hours of ablation. The 30-day ER utilization was 13.7%, similar to published data of same-day discharge of AF ablation done in the hospital setting. There were no emergent cardiac surgical interventions and no mortality events.

CONCLUSION: Catheter ablation for AF in the ambulatory setting is both feasible and safe in this large single-center experience. More studies are needed to confirm this next frontier in catheter ablation for AF.