Department of Cardiology, Heidelberg Center of Heart Rhythm Disorders, Medical University Hospital, Im Neuenheimer Feld 410, Heidelberg, Germany.
Health Economics Committee of EHRA (European Heart Rhythm Association).
Europace. 2024 Aug 3;26(8). doi: 10.1093/europace/euae200.
Same-day discharge (SDD) after catheter ablation of atrial fibrillation (AF) may address the growing socio-economic health burden of the increasing demand for interventional AF therapies. This systematic review and meta-analysis analyses the current evidence on clinical outcomes in SDD after AF ablation compared with overnight stay (ONS).
A systematic search of the PubMed database was performed. Pre-defined endpoints were complications at short-term (24-96 h) and 30-day post-discharge, re-hospitalization, and/or emergency room (ER) visits at 30-day post-discharge, and 30-day mortality. Twenty-four studies (154 716 patients) were included. Random-effects models were applied for meta-analyses of pooled endpoint prevalence in the SDD cohort and for comparison between SDD and ONS cohorts. Pooled estimates for complications after SDD were low both for short-term [2%; 95% confidence interval (CI): 1-5%; I2: 89%) and 30-day follow-up (2%; 95% CI: 1-4%; I2: 91%). There was no significant difference in complications rates between SDD and ONS [short-term: risk ratio (RR): 1.62; 95% CI: 0.52-5.01; I2: 37%; 30 days: RR: 0.65; 95% CI: 0.42-1.00; I2: 95%). Pooled rates of re-hospitalization/ER visits after SDD were 4% (95% CI: 1-10%; I2: 96%) with no statistically significant difference between SDD and ONS (RR: 0.86; 95% CI: 0.58-1.27; I2: 61%). Pooled 30-day mortality was low after SDD (0%; 95% CI: 0-1%; I2: 33%). All studies were subject to a relevant risk of bias, mainly due to study design.
In this meta-analysis including a large contemporary cohort, SDD after AF ablation was associated with low prevalence of post-discharge complications, re-hospitalizations/ER visits and mortality, and a similar risk compared with ONS. Due to limited quality of current evidence, further prospective, randomized trials are needed to confirm safety of SDD and define patient- and procedure-related prerequisites for successful and safe SDD strategies.
在心房颤动（AF）导管消融后进行当日出院（SDD）可能会解决日益增长的社会经济健康负担，这种负担源于对介入性 AF 治疗需求的增加。本系统评价和荟萃分析分析了与过夜留观（ONS）相比，在 AF 消融后进行 SDD 的短期和 30 天临床结局的现有证据。
对 PubMed 数据库进行了系统检索。预设的终点是短期（24-96 小时）和 30 天出院后并发症、30 天出院后再住院和/或急诊室（ER）就诊、30 天死亡率。共纳入 24 项研究（154716 例患者）。应用随机效应模型对 SDD 队列的汇总终点发生率进行荟萃分析，并对 SDD 与 ONS 队列进行比较。SDD 后短期（2%；95%置信区间（CI）：1-5%；I2：89%）和 30 天随访（2%；95%CI：1-4%；I2：91%）并发症的合并估计值较低。SDD 和 ONS 之间的并发症发生率无显著差异[短期：风险比（RR）：1.62；95%CI：0.52-5.01；I2：37%；30 天：RR：0.65；95%CI：0.42-1.00；I2：95%]。SDD 后再住院/ER 就诊的合并率为 4%（95%CI：1-10%；I2：96%），SDD 和 ONS 之间无统计学差异（RR：0.86；95%CI：0.58-1.27；I2：61%）。SDD 后 30 天死亡率较低（0%；95%CI：0-1%；I2：33%）。所有研究均存在相关的偏倚风险，主要是由于研究设计。
在这项包含大量当代队列的荟萃分析中，AF 消融后 SDD 与出院后并发症、再住院/ER 就诊和死亡率低相关，且与 ONS 相比风险相似。由于目前证据质量有限，需要进一步的前瞻性、随机试验来证实 SDD 的安全性，并确定成功和安全的 SDD 策略的患者和手术相关前提条件。
