Complications post atrial fibrillation ablation : same-day discharge versus overnight stay in adult

Abstract

Overview of the topic: Atrial fibrillation (AF) is a common type of an irregular heart rhythm also known as arrhythmia and is related to significant rates of mortality and morbidity (Rottner et al., 2020). Ablation is a procedure used to damage a small area of cardiac muscle intentionally to destroy the irregular electrical circuits (Singh et al., 2019). In this dissertation, same-day discharge (SDD) is used post catheter ablation as an intervention to assess complications, whilst overnight stay is used as a comparison. Some of the benefits of SDD are enhanced patient satisfaction, decreased duration of hospital stay, and more usage of healthcare resources. Complications of SDD include bleeding, haematoma, perforation, and procedure-related readmissions (Akula et al., 2020). A benefit of an overnight stay is that patients are closely monitored by healthcare professionals for bleeding or haematoma and the heart rhythm would be monitored using a cardiac monitor (Olshansky, 2022). Disadvantages of overnight stays include an increased risk of contracting healthcare acquired infections (HAI), the strain on healthcare resources and equipment, and an increase in patient anxiety. The research question: In adult patients undergoing catheter ablation for atrial fibrillation, does same-day discharge result in fewer complications compared to an overnight stay? PICO elements: The population (P) studied were adult patients (>18 years old) undergoing catheter ablation for AF. The intervention (I) explored was same-day discharge. The comparison (C) observed was overnight stay. The desired outcome (O) was fewer complications. Method: A systematic and comprehensive literature search was carried out using good quality databases. Keywords similar to the main terms of the PICO question were selected and linked using the Boolean operators. Limiters and inclusion/exclusion criteria were implemented to make the search more relevant and specific. The PRISMA flow diagram was used to exclude insignificant studies. The Critical Appraisal Skills Programme (CASP) tool was used to critically appraise the key studies. Results: Seven key studies were identified, which are four meta-analyses and three retrospective cohort studies. All the studies failed to reach statistically significant differences between groups. Therefore, it was concluded that the findings of the studies should be used with caution as RCTs are needed to validate the findings. Conclusion: An exact conclusion cannot be given, however from the available evidence, SDD appears to be safe and feasible having similar complications to an overnight stay and is therefore a safe strategy in selected patients. Implications and recommendations: Implementing criteria and protocols to identify suitable candidates for SDD, could improve patient safety and satisfaction. Also, investing in the latest technology would help to achieve better outcomes, resulting in better postprocedural care which promotes SDD. Further robust prospective, good-quality randomised controlled trials and local research are needed to verify the findings.