Pulmonary vein antrum isolation as a standalone outpatient procedure in low risk patients: a feasability evaluation

Pulmonary vein antrum isolation (PVAI) is an established treatment for Atrial Fibrillation (AF) refractory to medical therapy. A minimally-invasive procedure with low complication rates, PVAI is typically well tolerated and patients are usually discharged within the same or following day. Same-day discharge in lower-risk patients carries numerous benefits, including: greater patient satisfaction, reduced need for in-patient beds, lower exposure to nosocomial infections, and reduced healthcare costs. Baseline, procedure, and follow-up information were obtained for consecutive AF patients undergoing first-time PVAI at a tertiary care centre. All procedures utilized intracardiac echocardiography. Incidence of acute adverse events (AE) that necessitated admission, including any hematoma, pericardial tamponade, or arrhythmia that required treatment prior to discharge, were evaluated for patients meeting the lower risk criteria of: (a) paroxysmal AF, (b) age < 75, (c) BMI < 35, and (d) no history of congestive heart failure or stroke. The mean length of stay for this population was also calculated. Of the 1,656 patients (Mean age: 62.6±10.2, 36.9% female) undergoing PVAI between 2013-2021, 732 (44.2%) (mean age: 60.6±5.4 years, 38% female) were considered low risk as per above criteria. There were a total of 4 (0.56%) cases of AE post-PVI requiring potential overnight stays, including: 1 (0.14%) hematoma requiring treatment, 1 (0.14%) tamponade, and 2 (0.28%) cases of arrhythmia. Of the 2 patients experiencing post-procedure arrhythmia, one had recurrent AF requiring cardioversion and medication adjustment the morning after the procedure, and the other required temporary pacing for several hours following the procedure. There were no cases of cerebral ischemic events or deaths. The mean length of hospital stay in this group was 0.71±0.12 days. 5 (0.68%) patients visited an emergency department within 30 days post-PVAI for AF management. Given low AE rates among this low-risk patient subset (as specified above), PVAI demonstrates potential as an outpatient procedure without the need for overnight hospital stays. These patients could be safely treated at a standalone outpatient facility rather than a hospital with potential for significant health economic benefit.