Avoiding Bladder Catheters During Atrial Fibrillation Ablation

Ahmed, D; Clark, DO Brad A.; Joshi, Sandeep; Nair, Girish V.; Olson, DO Jeffrey A.; Padanilam, Benzy J.; Patel, Parin J.

doi:10.1016/j.jacep.2019.10.003

Cited by 8 publications

(8 citation statements)

References 11 publications

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“…A recent randomized controlled trial indicated that AF ablation can be safely performed without an indwelling urinary catheter in procedures with an average duration of 3 hours. The absence of an indwelling urinary catheter did not significantly increase the risk of urinary retention but did decrease the risk of hematuria and dysuria, compared to the use of an indwelling urinary catheter 12 . For patients who are found to have orthostatic vital signs or ambulation difficulties upon completing bedrest, encouragement of oral intake, hydration with IV fluids, or avoidance of vaso‐depressing medications (opiates, beta blockers, anti‐hypertensive agents, diuretics, etc.)…”

Section: Discussionmentioning

confidence: 97%

Barriers and financial impact of same‐day discharge after atrial fibrillation ablation

Chu

Zhang

Musikantow

et al. 2021

Pacing Clinical Electrophis

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Background Same‐day discharge (SDD) after atrial fibrillation (AF) ablation is increasingly being considered. This study examined the barriers and financial impact associated with SDD in a contemporary cohort of patients undergoing elective AF ablation. Methods A single center retrospective review was conducted of the 249 first case‐of‐the‐day outpatient AF ablations performed in 2019 to evaluate the proportion of patients that could have undergone SDD. Barriers to SDD were defined as any intervention that prevented SDD by 8 p.m. The financial impact of SDD was based on savings from avoidance of the overnight hospital stay and revenue related to management of chest pain facilitated by a vacant hospital bed. Results SDD could have occurred in 157 patients (63%) without change in management and in up to 200 patients (80%) if avoidable barriers were addressed. Barriers to SDD included non‐clinical logistical issues (43%), prolonged post‐procedure recovery (42%) and minor procedural complications (15%). On multivariate analysis, factors associated with barriers to SDD included increasing age (P = .01), left ventricular ejection fraction ≤ 35% (P = .04), and severely dilated left atrium (P = .04). The financial gain from SDD would have ranged from $1,110,096 (assuming discharge of 63% of eligible patients) to $1,480,128 (assuming 80% discharge) over the course of a year. Conclusions Up to 80% of patients undergoing outpatient AF ablation were amenable to SDD if avoidable delays in care had been anticipated. Based on reduced hospital operating expenses and increased revenue from management of individuals with chest pain, this would translate to a financial savings of ∼$1.5 million.

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Section: Discussionmentioning

confidence: 97%

Barriers and financial impact of same‐day discharge after atrial fibrillation ablation

Chu

Zhang

Musikantow

et al. 2021

Pacing Clinical Electrophis

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“…Although these results are consistent with the FIRE and ICE 4 randomized trial of CBA versus RFA for paroxysmal AF, it is worth noting that the rate of phrenic nerve injury is lower in the current study compared to FIRE and ICE, in which it occurred acutely in 2.7% of patients. The increase in volume overload and urinary tract infections (presumably related to the use of indwelling foley catheters 16 ) are likely related to the volume and salt load from the continuous irrigation of RFA catheters. Volume overload could be mitigated by RFA catheters that require less irrigation 17 or through prophylactic diuretic use in higher‐risk patients.…”

Section: Discussionmentioning

confidence: 99%

“…Volume overload could be mitigated by RFA catheters that require less irrigation 17 or through prophylactic diuretic use in higher‐risk patients. Differences in urinary tract infections could potentially be mitigated by minimizing the use of foley catheters 16 or using prophylactic antibiotics 18 when indwelling bladder catheterization is required.…”

Section: Discussionmentioning

confidence: 99%

Procedure characteristics and outcomes of atrial fibrillation ablation procedures using cryoballoon versus radiofrequency ablation: A report from the GWTG‐AFIB registry

Friedman

Holmes

Curtis

et al. 2021

Cardiovasc electrophysiol

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Introduction Cryoballoon ablation (CBA) is an alternative to radiofrequency ablation (RFA) for ablation of atrial fibrillation (AF) and real‐world comparisons of this strategy are lacking. As such, we sought to compare patient and periprocedural characteristics and outcomes of CBA versus RFA in the Get With the Guidelines AFIB Registry. Methods Categorical variables were compared via the χ2 test and continuous variables were compared via the Wilcoxon rank‐sum test. Adjusted analyses were performed using overlap weighting of propensity scores. Results A total of 5247 (1465 CBA, 3782 RFA) ablation procedures were reported from 33 sites. Those undergoing CBA more often had paroxysmal AF (60.0% vs. 48.8%) and no prior AF ablation (87.5% vs. 73.8%). CHA2DS2‐VASc scores were similar. Among de novo ablations, most ablations involved intracardiac echocardiography and electroanatomic mapping, but both were less common with CBA (87.3% vs. 93.9%, p < .0001, and 87.7% vs. 94.6%, p < .0001, respectively). CBA was associated with shorter procedures (129 vs. 179 min, p < .0001), increased fluoroscopy use (19 vs. 11 min, p < .0001), and similar ablation times (27 vs. 35 min, p = .15). Nonpulmonary vein ablation was common with CBA: roof line 38.6%, floor line 20.4%, cavotricuspid isthmus 27.7%. RFA was associated with more total complications compared to CBA (5.4% vs. 2.3%, p < .0001), due to more volume overload and “other” events, although phrenic nerve injury was more common with CBA (0.9% vs 0.1%, p = .0001). In the adjusted model, any complication was less common among CBA cases (odds ratio, 0.45; confidence interval, 0.25–0.79, p = .0056). Conclusion CBA was associated with fewer complications, and shorter procedure times, and greater fluoroscopy times, compared to RFA. Nonpulmonary vein ablation and electroanatomic mapping system use was common with CBA.

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“…Another recent, open-label trial did not find a reduction in pericarditis with colchicine 0.6 mg twice daily administered for 7 days following catheter ablation. 25 However, periablation use of colchicine was associated with a reduction in pericarditis in a recent observational study. 26…”

Section: Discussionmentioning

confidence: 96%

Colchicine to Prevent Atrial Fibrillation Recurrence After Catheter Ablation: A Randomized, Placebo-Controlled Trial

Benz,

Amit,

Connolly

et al. 2024

Circ: Arrhythmia and Electrophysiology

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BACKGROUND: Inflammation may promote atrial fibrillation (AF) recurrence after catheter ablation. This study aimed to evaluate a short-term anti-inflammatory treatment with colchicine following ablation of AF. METHODS: Patients scheduled for ablation were randomized to receive colchicine 0.6 mg twice daily or placebo for 10 days. The first dose of the study drug was administered within 4 hours before ablation. Atrial arrhythmia recurrence was defined as AF, atrial flutter, or atrial tachycardia >30 s on two 14-day Holters performed immediately and at 3 months following ablation. RESULTS: The modified intention-to-treat population included 199 patients (median age, 61 years; 22% female; 70% first procedure) who underwent radiofrequency (79%) or cryoballoon ablation (21%) of AF. Antiarrhythmic drugs were prescribed at discharge in 149 (75%) patients. Colchicine did not prevent atrial arrhythmia recurrence at 2 weeks (31% versus 32%; hazard ratio [HR], 0.98 [95% CI, 0.59–1.61]; P =0.92) or at 3 months following ablation (14% versus 15%; HR, 0.95 [95% CI, 0.45–2.02]; P =0.89). Postablation chest pain consistent with pericarditis was reduced with colchicine (4% versus 15%; HR, 0.26 [95% CI, 0.09–0.77]; P =0.02) and colchicine increased diarrhea (26% versus 7%; HR, 4.74 [95% CI, 1.95–11.53]; P <0.001). During a median follow-up of 1.3 years, colchicine did not reduce a composite of emergency department visit, cardiovascular hospitalization, cardioversion, or repeat ablation (29 versus 25 per 100 patient-years; HR, 1.18 [95% CI, 0.69–1.99]; P =0.55). CONCLUSIONS: Colchicine administered for 10 days following catheter ablation did not reduce atrial arrhythmia recurrence or AF-associated clinical events, but did reduce postablation chest pain and increased diarrhea.

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Avoiding Bladder Catheters During Atrial Fibrillation Ablation

Cited by 8 publications

References 11 publications

Barriers and financial impact of same‐day discharge after atrial fibrillation ablation

Barriers and financial impact of same‐day discharge after atrial fibrillation ablation

Procedure characteristics and outcomes of atrial fibrillation ablation procedures using cryoballoon versus radiofrequency ablation: A report from the GWTG‐AFIB registry

Colchicine to Prevent Atrial Fibrillation Recurrence After Catheter Ablation: A Randomized, Placebo-Controlled Trial

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