Same-Day Discharge Criteria Outlined for AF Ablation

Medscape

02-06-2025

SAN DIEGO — Same-day discharge after ablation of atrial fibrillation (AF) is an appropriate strategy for saving costs if performed with strict selection criteria and protocols, according to a recently issued joint statement from the American College of Cardiology and the Heart Rhythm Society.
Same-day discharge has long been indicated for catheter ablations to abort routine atrial flutter, atrioventricular nodal reentrant tachycardia, and focal atrial tachycardias, according to the authors of the new joint statement. Although they maintained patients selected for elective catheter ablation of AF require heightened scrutiny, they endorsed same-day AF ablation when used selectively.
The statement evaluates 'evidence supporting shorter hospitalization stay with same-day discharge for intracardiac ablations agonistic to site of care,' reported Amit J. Shankar, MD , an electrophysiologist with Canton-Potsdam Hospital in Potsdam, New York, who served as a representative for the Heart Rhythm Society in developing the statement.
Whether in a hospital setting or an outpatient facility, the statement describes same-day discharge ablation as an opportunity to improve patient access, improve efficiency, and reduce healthcare costs.
The adoption of same-day discharge after AF ablation was accelerated during the COVID-19 pandemic, said Samuel O. Jones, MD, a cardiologist affiliated with The Chattanooga Heart Institute in Chattanooga, Tennessee, and a fellow of the American College of Cardiology. 'Improved workflows, technological innovations, and procedure advancements have also contributed to the high rates at which these are performed,' added Jones, who helped write the statement.
The statement was released on April 24 to coincide with the first day of the Heart Rhythm Society (HRS) 2025 annual scientific meeting. It was simultaneously published in Heart Rhythm and the Journal of the American College of Cardiology .
The scientific statement's recommendation is intended for elective rather than urgent or emergency ablations.
Support for the statement was drawn from multiple case-controlled studies, meta-analyses, and outcome databases. In one example, a 12-study meta-analysis with data from more than 18,000 elective ablations showed no significant differences in major complications from the procedure among the 40.5% of patients discharged the same day relative to those who were discharged after at least one night in the hospital.
In another study, drawn from a real-world prospective registry, outcomes were compared for potential candidates for same-day ablation on the basis of prespecified criteria and those who were not eligible for the procedure. These criteria included no bleeding history, a left ventricular ejection fraction greater than 40%, no pulmonary disease, and no surgical procedures within the previous 60 days.
Of the 2332 patients included in the analysis, 1982 (85%) were deemed candidates for same-day ablation. Although freedom for atrial arrhythmias was comparable ( P = .0212) for the two groups, patients discharged the same day had a lower rate of complications (0.8% vs 2.9%; P < .001). The rate of readmission was similar (0.8% vs 09%; P = .924), according to the researchers.
Contraindications for Same-Day Ablation
In the document, relative contraindications for same-day ablation include decompensated heart failure, significant pulmonary disease, significant risk of bleeding, and any major unstable comorbidities such as diabetes, hypertension, or renal disease.
The document recommends limiting same-day procedures to patients who can have readily available social support and can return to a hospital quickly in the event of a post-procedural complication.
Acknowledging that most large hospitals offering ablation for AF already have formal selection criteria and protocols in place for same-day discharge, the authors called for free-standing sites to establish their own if they have not done so. In these settings, the authors emphasized the need to rigorously follow prespecified and 'ironclad' selection criteria and protocols.
From this standpoint, Shankar said same-day procedures should always be performed on the basis of shared decision-making with the patient. While the economic benefits of same-day procedures might be shared by the facility and the patient, the latter should understand the inherent differences in the settings and participate actively in any decision of where the ablation is performed.
Jones said while a substantial body of evidence supports same-day AF ablation as a safe and effective procedure that can free up necessary resources in the healthcare facility, the potential advantages are relevant only to appropriately selected patients.
The new statement also suggests transfer agreements with inpatient facilities should be arranged in advance and that patients should be informed such a transfer is a possibility outside of a hospital setting.
However, the document makes clear same-day ablations in alternative sites of care are reasonable when the precautions are observed.
In any setting that AF ablation is performed, the writing committee encouraged tracking outcomes to ensure that high-quality care is achieved and sustained.
Shankar and Jones reported no potential conflicts of interest.