Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA.
J Interv Card Electrophysiol. 2022 Oct;65(1):209-217. doi: 10.1007/s10840-022-01255-4. Epub 2022 May 28.
While initial studies suggest that same-day discharge or shortened bedrest may be feasible for some patients following atrial fibrillation (AF) ablation, the risks and benefits of this approach remain unclear for patients undergoing hemostasis with figure-of-eight (FO8) suture technique.
We prospectively evaluated access site bleeding, length of hospitalization, urinary catheterization, and other clinical outcomes in patients undergoing AF ablation with 3 hours of bedrest between April and May 2021, and compared them to a control group that had undergone AF ablation with 6 hours of bedrest from April to July 2019. FO8 sutures were used for hemostasis in all patients. Independent risk factors for bleeding and urinary catheterization were determined using multiple logistic regression.
Same-day discharge was achieved in 74% of patients in the 3-hour bedrest group compared to 7% of patients in the 6-hour bedrest group (p < 0.001). There were no differences between 3-hour and 6-hour bedrest groups in the rates of serious adverse events (2% vs. 1%, p = 0.45) or rehospitalizations or ED visits (1% vs. 3%, p = 0.45) within 30 days of ablation. The 3-hour bedrest group showed a non-significant trend toward more access site bleeding (15% vs. 8%, p = 0.10), but had a significant reduction in urinary catheterization (27% vs. 64%, p < 0.001) and opioid analgesia use (20% vs. 33%, p = 0.04).
Same-day discharge after 3 hours of bedrest is safe and feasible following AF ablation and is not associated with higher rates of complications or rehospitalizations at 30 days. Reduced bedrest resulted in decreased opioid analgesia and urinary catheterization.
尽管初步研究表明，对于某些接受心房颤动（AF）消融的患者，当日出院或缩短卧床休息时间可能是可行的，但对于采用 8 字缝合技术进行止血的患者，这种方法的风险和益处尚不清楚。
我们前瞻性评估了 2021 年 4 月至 5 月期间接受 3 小时卧床休息的 AF 消融患者的血管穿刺部位出血、住院时间、导尿和其他临床结局，并与 2019 年 4 月至 7 月接受 6 小时卧床休息的对照组进行比较。所有患者均采用 8 字缝合进行止血。使用多因素逻辑回归确定出血和导尿的独立危险因素。
在 3 小时卧床休息组中，74%的患者可当日出院，而 6 小时卧床休息组中只有 7%的患者可当日出院（p<0.001）。在 3 小时卧床休息组和 6 小时卧床休息组中，严重不良事件（2%比 1%，p=0.45）或 30 天内再住院或急诊就诊（1%比 3%，p=0.45）的发生率没有差异。3 小时卧床休息组血管穿刺部位出血发生率呈非显著升高趋势（15%比 8%，p=0.10），但导尿（27%比 64%，p<0.001）和阿片类镇痛药使用（20%比 33%，p=0.04）显著减少。
在接受 3 小时卧床休息后，当日出院是安全可行的，并且与 30 天内的并发症或再住院率增加无关。减少卧床休息可减少阿片类镇痛药和导尿的使用。
