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Meta-Analysis
. 2024 Aug 3;26(8):euae200.
doi: 10.1093/europace/euae200.

Same-day discharge vs. overnight stay following catheter ablation for atrial fibrillation: a comprehensive review and meta-analysis by the European Heart Rhythm Association Health Economics Committee

Maura M Zylla  1   2 , Jacopo F Imberti  3   4 , Francisco Leyva  2   5 , Ruben Casado-Arroyo  2   6 , Frieder Braunschweig  2   7   8 , Helmut Pürerfellner  9 , José L Merino  10 , Giuseppe Boriani  2   3
Affiliations
Meta-Analysis

Same-day discharge vs. overnight stay following catheter ablation for atrial fibrillation: a comprehensive review and meta-analysis by the European Heart Rhythm Association Health Economics Committee

Maura M Zylla et al. Europace. .

Abstract

Aims: 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).

Methods and results: 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.

Conclusion: 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.

Keywords: Atrial fibrillation; Catheter ablation; Complications; Mortality; Re-hospitalization; Same-day discharge.

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Conflict of interest statement

Conflict of interest: M.M.Z. reports lecture fees/honoraria and travel support by Medtronic, Boston Scientific, Bayer Vital, Pfizer, Abbott, and ZOLL CMS. F.L. is a consultant to and has received financial research support from Medtronic, Abbott, Boston Scientific, Biotronik, and MicroPort. R.C.-A. has received small amounts for educational meetings from Abbott and Boston Scientific. F.B. has received fees from Medtronic and Biotronik for trial committee assignments. Other industry collaborations are handled through the employer with no personal fees paid to FB. H.P. reports honoraria for lectures and scientific advice from Abbott, Boston Scientific, Biosense Webster, and Medtronic. J.L.M reports fees and honoraria for lectures, education and scientific advice from Biotronik, MicroPort, and Zoll. G.B. reports small speaker fees from Bayer, Boehringer Ingelheim, Boston, Daiichi Sankyo, Janssen, and Sanofi outside of the submitted work. The other authors have no conflict of interest to disclose.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Study selection process (PRISMA flowchart). SDD, same-day discharge.
Figure 2
Figure 2
Forest plots showing the comparative safety of same-day discharge strategy vs. overnight stay after catheter ablation of atrial fibrillation. (A) Risk of short-term complications. (B) Risk of complications at 30 days. (C) Risk of death at 30 days. (D) Risk of unplanned medical contact at 30 days. CI, confidence ratio; ONS, overnight stay; RR, risk ratio; SDD, same-day discharge.
See this image and copyright information in PMC

References

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