Royal Berkshire Hospital, Royal Berkshire Hospitals NHS Foundation Trust, RG1 5AN Reading, UK.
Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, OX3 9DU Oxford, UK.
Europace. 2022 Oct 13;24(10):1569-1584. doi: 10.1093/europace/euac068.
Catheter ablation for atrial fibrillation (AF) has historically required inpatient admission post-procedure, but same-day discharge (SDD) has recently been reported. We aimed to assess the efficacy and safety of SDD compared with overnight stay (OS) post-ablation.
We performed a systematic search of the PubMed database. Random-effects meta-analysis was performed to assess the efficacy (successful SDD) and safety (24 h complications, 30-day complications, 30-day re-admissions, and 30-day mortality) of a SDD AF ablation strategy. Fourteen non-randomized observational studies met criteria for inclusion, encompassing 26488 patients undergoing AF ablation, of whom 9766 were SDD. The mean age of participants was 61.9 years, and 67.9% were male. Around 61.7% underwent ablation for paroxysmal AF. The pooled success rate of SDD was 83.2% [95% confidence intervals (CIs): 61.5-97.0%, I2 100%]. The risk of bias was severe for all effect estimates due to confounding, as most cohorts were retrospectively identified without appropriately matched comparators. There was no significant difference in 30-day complications [odds ratio (OR): 0.95, 95% CI: 0.65-1.40, I2 53%] or 30-day re-admission (OR 0.96, 95% CI: 0.49-1.89, I2 82%) between groups. There were insufficient data for meta-analysis of 24 h complications and 30-day mortality. Where reported, no re-admissions occurred due to 24 h complications after SDD. Two deaths (0.04%) were reported in both SDD and OS groups.
Same-day discharge after AF ablation appears to be an effective and safe strategy in selected patients. However, the available evidence is of low quality, and more robust prospective studies comparing SDD to OS are needed.
房颤（AF）的导管消融术传统上需要在术后住院，但最近已经有报道称可以当天出院（SDD）。我们旨在评估与消融后过夜（OS）相比，SDD 的疗效和安全性。
我们对 PubMed 数据库进行了系统搜索。采用随机效应荟萃分析评估 SDD 治疗策略的疗效（成功 SDD）和安全性（24 小时并发症、30 天并发症、30 天再入院和 30 天死亡率）。有 14 项非随机观察性研究符合纳入标准，共纳入 26488 例接受 AF 消融的患者，其中 9766 例为 SDD。参与者的平均年龄为 61.9 岁，67.9%为男性。约 61.7%的患者因阵发性 AF 接受消融。SDD 的总体成功率为 83.2%[95%置信区间（CI）：61.5-97.0%，I²为 100%]。由于混杂因素，所有效应估计的偏倚风险都很高，因为大多数队列都是回顾性确定的，没有适当匹配的对照。两组之间 30 天并发症（OR：0.95，95%CI：0.65-1.40，I²为 53%）或 30 天再入院（OR：0.96，95%CI：0.49-1.89，I²为 82%）的风险无显著差异。由于缺乏数据，因此无法对 24 小时并发症和 30 天死亡率进行荟萃分析。在 SDD 后，报告的再入院病例均无 24 小时并发症。两组均有 2 例死亡（0.04%）。
在选择的患者中，AF 消融术后当天出院似乎是一种有效且安全的策略。然而，现有证据质量较低，需要更多比较 SDD 与 OS 的前瞻性研究。
