Willcox Mark E, Baker Inara, Sedwick Jack, Cerveny Matthew, Compton Steven J
Alaska Heart and Vascular Institute, Anchorage, Alaska.
Alaska Cardiovascular Surgery Center, Alaska Heart and Vascular Institute, Anchorage, Alaska.
Heart Rhythm O2. 2023 Jun 30;4(8):478-482. doi: 10.1016/j.hroo.2023.06.010. eCollection 2023 Aug.
The safety of atrial fibrillation (AF) ablation in an ambulatory outpatient center has not previously been reported.
The aim of this study is to report the feasibility and safety of AF ablation in an ambulatory setting.
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.
A total of 476 patients underwent pulmonary vein isolation in the ambulatory setting over a 6.3-year period. Patients' average age was 58 ± 9.3 years, body mass index was 32.9 kg/m, and the CHADS-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.
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.
此前尚未报道在门诊流动中心进行心房颤动（AF）消融的安全性。
本研究旨在报告在流动环境下进行AF消融的可行性和安全性。
我们使用计费记录确定了自阿拉斯加心脏与血管研究所门诊中心项目启动至当前所进行的所有AF消融手术。通过病历审查获取手术并发症、术后医院服务利用情况以及急诊室（ER）利用情况。
在6.3年的时间里，共有476例患者在门诊环境下接受了肺静脉隔离术。患者的平均年龄为58±9.3岁，体重指数为32.9kg/m²，CHADS-VASc（充血性心力衰竭、高血压、年龄≥75岁、糖尿病、既往卒中或短暂性脑缺血发作或血栓栓塞、血管疾病、年龄65 - 74岁、性别类别）评分为1.7。其中85%为首次进行AF消融，55%患有阵发性AF。85%使用了冷冻消融。一项综合主要安全结局指标，即捕获潜在不稳定围手术期安全事件，发生在1.5%的患者中，所有这些患者在转院之前病情均已稳定。共有1.5%的患者需要当日住院服务，另有1.5%的患者在24小时内返回急诊室。共有96%的患者在消融后24小时内不需要住院服务。30天急诊室利用率为13.7%，与已发表的医院环境下AF消融当日出院的数据相似。没有进行紧急心脏外科干预，也没有死亡事件。
在这个大型单中心经验中，门诊环境下进行AF导管消融是可行且安全的。需要更多研究来证实AF导管消融的这一新领域。
