Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
Johnson & Johnson Medical Devices, Franchise Health Economics and Market Access, Irvine, California, USA.
J Cardiovasc Electrophysiol. 2021 Sep;32(9):2432-2440. doi: 10.1111/jce.15193. Epub 2021 Aug 5.
Catheter ablation (CA) is a common treatment for atrial fibrillation (AF). This study evaluated outcomes of same day discharge (SDD) versus overnight stay (ONS) among AF patients undergoing outpatient CA.
The Optum SES Clinformatics Extended Data Mart database was used to identify patients ≥18 years of age undergoing outpatient CA for AF (2016-2020). Eligible patients were indexed to the date of first CA and classified into SDD and ONS groups based on the length of service. A 1:3 propensity score matching was used to create comparable SDD:ONS samples. The primary safety outcome was CA-related complications within 30 days of index procedure. The primary efficacy outcome was AF recurrence within 1 year. Cox proportional hazards models were estimated for outcome comparison.
In the postmatch 30-day cohort for safety evaluation, there were 6600 patients (1660 [25.2%] SDD; 4940 [74.8%] ONS), with a mean age of 66.6 years. There was no significant difference in the 30-day composite rate of postablation complications (4.7% [78/1660] vs. 3.8% [187/4940]; p = 0.100) and 1-year composite rate of AF recurrence (14.3% [142/996] vs. 14.5% [430/2972]; p = 0.705) between the SDD and ONS groups.
This study demonstrated that SDD following CA to treat patients with AF is safe, with low rates of postablation complications and AF recurrence, which were comparable to rates in patients with an ONS after CA.
导管消融（CA）是治疗心房颤动（AF）的常用方法。本研究评估了门诊 CA 治疗 AF 患者中当天出院（SDD）与过夜留观（ONS）的结局。
使用 Optum SES Clinformatics 扩展数据集市数据库，确定 2016 年至 2020 年期间年龄≥18 岁接受门诊 CA 治疗 AF 的患者。符合条件的患者以首次 CA 日期为索引，并根据住院时间分为 SDD 和 ONS 组。采用 1:3 倾向评分匹配创建可比的 SDD：ONS 样本。主要安全性结局为索引手术后 30 天内的 CA 相关并发症。主要疗效结局为 1 年内 AF 复发。使用 Cox 比例风险模型比较结局。
在安全性评估的匹配后 30 天队列中，共有 6600 例患者（1660 例 SDD[25.2%]；4940 例 ONS[74.8%]），平均年龄为 66.6 岁。SDD 组和 ONS 组 30 天复合术后并发症发生率（4.7%[78/1660] vs. 3.8%[187/4940]；p=0.100）和 1 年 AF 复发的复合发生率（14.3%[142/996] vs. 14.5%[430/2972]；p=0.705）均无显著差异。
本研究表明，门诊 CA 治疗 AF 患者的 SDD 是安全的，术后并发症和 AF 复发率较低，与 CA 后 ONS 患者的发生率相当。
