Performance of the REAL-AF Same-Day Discharge Protocol in Patients Undergoing Catheter Ablation of Atrial Fibrillation.

Humans Atrial Fibrillation Catheter Ablation Patient Discharge Stroke Volume Treatment Outcome Ventricular Function, Left
atrial fibrillation cardiac arrhythmia catheter ablation radiofrequency ablation same-day discharge

Journal

JACC. Clinical electrophysiology
ISSN: 2405-5018
Titre abrégé: JACC Clin Electrophysiol
Pays: United States
ID NLM: 101656995

Informations de publication

Date de publication:
08 2023
Historique:
received: 27 03 2023
revised: 19 04 2023
accepted: 20 04 2023
medline: 25 8 2023
pubmed: 19 5 2023
entrez: 19 5 2023
Statut: ppublish

Résumé

Same-day discharge (SDD) after catheter ablation of atrial fibrillation (AF) has been widely adopted. Nevertheless, planned SDD has been performed by using subjective criteria rather than standardized protocols. The goal of this study was to determine the efficacy and safety of the previously described SDD protocol in a prospective multicenter study. Using the REAL-AF (Real-world Experience of Catheter Ablation for the Treatment of Paroxysmal and Persistent Atrial Fibrillation) SDD protocol eligibility criteria (stable anticoagulation, no bleeding history, left ventricular ejection fraction >40%, no pulmonary disease, no procedures within 60 days, and body mass index <35 kg/m A total of 2,332 patients were included. The REAL-AF SDD protocol identified 1,982 (85%) patients as potential candidates for SDD. The primary efficacy endpoint was achieved in 1,707 (86.1%) patients. The readmission rate for SDD vs non-SDD group was similar (0.8% vs 0.9%; P = 0.924). The SDD group had a lower acute complication rate than the non-SDD group (0.8% vs 2.9%; P < 0.001), and there was no difference in the subacute complication rate between groups (P = 0.513). Freedom from all-atrial arrhythmias was comparable between groups (P = 0.212). In this large, multicenter prospective registry, the use of a standardized protocol showed the safety of SDD after catheter ablation of paroxysmal and persistent AF. (Real-world Experience of Catheter Ablation for the Treatment of Paroxysmal and Persistent Atrial Fibrillation [REAL-AF]; NCT04088071).

Sections du résumé

BACKGROUND
Same-day discharge (SDD) after catheter ablation of atrial fibrillation (AF) has been widely adopted. Nevertheless, planned SDD has been performed by using subjective criteria rather than standardized protocols.
OBJECTIVES
The goal of this study was to determine the efficacy and safety of the previously described SDD protocol in a prospective multicenter study.
METHODS
Using the REAL-AF (Real-world Experience of Catheter Ablation for the Treatment of Paroxysmal and Persistent Atrial Fibrillation) SDD protocol eligibility criteria (stable anticoagulation, no bleeding history, left ventricular ejection fraction >40%, no pulmonary disease, no procedures within 60 days, and body mass index <35 kg/m
RESULTS
A total of 2,332 patients were included. The REAL-AF SDD protocol identified 1,982 (85%) patients as potential candidates for SDD. The primary efficacy endpoint was achieved in 1,707 (86.1%) patients. The readmission rate for SDD vs non-SDD group was similar (0.8% vs 0.9%; P = 0.924). The SDD group had a lower acute complication rate than the non-SDD group (0.8% vs 2.9%; P < 0.001), and there was no difference in the subacute complication rate between groups (P = 0.513). Freedom from all-atrial arrhythmias was comparable between groups (P = 0.212).
CONCLUSIONS
In this large, multicenter prospective registry, the use of a standardized protocol showed the safety of SDD after catheter ablation of paroxysmal and persistent AF. (Real-world Experience of Catheter Ablation for the Treatment of Paroxysmal and Persistent Atrial Fibrillation [REAL-AF]; NCT04088071).

Identifiants

DOI: 10.1016/j.jacep.2023.04.014 PMID: 37204358
pubmed: 37204358
pii: S2405-500X(23)00267-0
doi: 10.1016/j.jacep.2023.04.014
pii:
doi:

Banques de données

ClinicalTrials.gov
['NCT04088071']

Types de publication

Clinical Study Journal Article Multicenter Study Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

1515-1526

Commentaires et corrections

Type : CommentIn

Informations de copyright

Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Funding Support and Author Disclosures This work was supported by Biosense Webster, Inc. The REAL-AF registry is funded through an investigator-initiated research grant (Principal Investigator: Dr. Osorio) from Biosense Webster Inc. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Auteurs

Anil Rajendra (A)

Arrhythmia Institute at Grandview, Grandview Medical Center, Birmingham, Alabama, USA.

Jose Osorio (J)

Arrhythmia Institute at Grandview, Grandview Medical Center, Birmingham, Alabama, USA.

Juan C Diaz (JC)

Cardiac Arrhythmia and Electrophysiology Service, Clinica Las Vegas, Medellin, Colombia.

Carolina Hoyos (C)

Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.

Estefanía Rivera (E)

Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.

Carlos D Matos (CD)

Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.

Alexandru Costea (A)

Heart & Vascular Institute, The Christ Hospital Medical Center, Liberty Township, Ohio, USA.

Allyson L Varley (AL)

Heart Rhythm Clinical and Research Solutions, Birmingham, Alabama, USA.

Christopher Thorne (C)

Heart Rhythm Clinical and Research Solutions, Birmingham, Alabama, USA.

Michael Hoskins (M)

New Mexico Heart Institute, Albuquerque, New Mexico, USA.

Sandeep Goyal (S)

Piedmont Heart Institute Buckhead, Atlanta, Georgia, USA.

Saumil Oza (S)

Ascension Medical Group, St. Vincent's Cardiology, Jacksonville, Florida, USA.

Anthony Magnano (A)

Ascension Medical Group, St. Vincent's Cardiology, Jacksonville, Florida, USA.

Benjamin D'Souza (B)

Penn Heart and Vascular Center Cherry Hill, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania, USA.

Joshua Silverstein (J)

Electrophysiology Service, AHN Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA.

Mark Metzl (M)

NorthShore University HealthSystem, Evanston, Illinois, USA.

Paul C Zei (PC)

Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.

Jorge E Romero (JE)

Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. Electronic address: jeromero@bwh.harvard.edu.

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Performance of the REAL-AF Same-Day Discharge...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Troubles du rythme cardiaque › Fibrillation auriculaire › Performance of the REAL-AF Same-Day Discharge...
questionsmedicales.fr › Procédures de chirurgie opératoire › Techniques d'ablation › Ablation par radiofréquence › Ablation par cathéter › Performance of the REAL-AF Same-Day Discharge...
questionsmedicales.fr › Administration des services de santé › Gestion des soins aux patients › Services de santé polyvalents › Soins de santé primaires › Continuité des soins › Sortie du patient › Performance of the REAL-AF Same-Day Discharge...
questionsmedicales.fr › Phénomènes physiologiques respiratoires et circulatoires › Phénomènes physiologiques cardiovasculaires › Hémodynamique › Débit cardiaque › Débit systolique › Performance of the REAL-AF Same-Day Discharge...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Évaluation des résultats et des processus en soins de santé › Évaluation de résultat (soins) › Résultat thérapeutique › Performance of the REAL-AF Same-Day Discharge...
questionsmedicales.fr › Phénomènes physiologiques respiratoires et circulatoires › Phénomènes physiologiques cardiovasculaires › Fonction ventriculaire › Fonction ventriculaire gauche › Performance of the REAL-AF Same-Day Discharge...