Complication Rates Between Same-Day And Next-Day Discharge Of Left Atrial Ablation Procedures: A Parallel, Intra-Institutional Comparison

Introduction: Over a two-year period, two high-volume electrophysiology centers simultaneously performed left atrial ablation with differing post-procedure discharge strategies. We sought to investigate complication rates between patients undergoing same-day (SD) or next-day (ND) discharges. Methods: We identified all patients who underwent transseptal ablation from August 2017 to August 2019 (n = 409) at two high-volume centers practicing either SD (n = 210) or ND (n = 199) discharge protocols. Atrial fibrillation, left atrial flutter and left atrial tachycardia ablations were included in the study while left atrial accessory pathway ablations were not. Complications were defined as any clinical event that resulted in procedural abortion, extended stay for either center, or readmission within 72 hours. The primary endpoint included a composite of major and minor complications ranging in clinical significance from cerebrovascular accident and cardiac tamponade to significant laboratory derangements. Results: Among this cohort, average age was 63.9 +/-11 years and 32.3% of patients were female. 93.9% of procedures were for atrial fibrillation, the remainder were for left atrial flutter or left atrial tachycardia. The composite endpoint of overall complication rate was similar between SD and ND discharge (14.3% vs 12.6%, p = 0.665). Rates of complications categorized as major (2.4% vs 3.0%, p = 0. 776) and minor (11.9% vs 9.5%, p = 0.524) were also similar. Multivariable regression modeling revealed no significant correlation between discharge strategy and complication occurrence (OR 1.565 [0.754 - 3.248], p = 0.23), but a positive association of hypertension and procedure duration with complications (OR 3.428 [1.436 - 8.184], p = 0.006) and (OR 1.01 [1 - 1.019], p = 0.046) respectively. Conclusions: Left atrial ablation complication rates were similar between SD and ND discharge practices while hypertension and procedural duration were positively correlated with complications. These data, which represent the first side-by-side comparison of discharge strategy, suggest same-day discharge is safe and feasible for left atrial ablation procedures.