Avoiding Urinary Catheterization in Patients Undergoing Atrial Fibrillation Catheter Ablation

Abstract

Indwelling urinary catheters are commonly inserted when administering general anesthesia. However, there are significant risks to routine IUC insertion. We compared urinary and other outcomes in a population of patients undergoing atrial fibrillation (AF) ablation with or without IUC. Methods: This was a single center, retrospective review of patients undergoing AF ablation. Patients were identified by procedure codes and patient health characteristics and outcome data were manually extracted from electronic health records. The primary composite endpoint was 7-day periprocedural urinary outcomes including cystitis, dysuria, hematuria, urethral damage, or urinary retention. Results: 404 patients were included in the study, 297 with IUC and 107 without IUC. Uncatheterized patients were less likely to have congestive heart failure (CHF) (31.8% vs 43.4%; P = 0.039) and had a shorter procedure length (4.2 vs 4.9 hours; P < 0.001) with less fluid administered (1485 vs 2040 mL; P < 0.001). No urinary complications occurred in the uncatheterized group versus 14 in the catheterized group (P = 0.026). 3 patients in the uncatheterized group developed serious infections versus none in the catheterized group (P = 0.018). There was no incidence of death and no statistically significant difference in readmission in the 30 days after procedure. Conclusions: There were no urinary complications in 107 patients who received no IUC during AF ablation. Avoiding bladder catheters during AF ablation procedures may lower incidence of adverse urinary complications without adding substantial risk of urinary retention.

Sex-based differences in atrial fibrillation ablation adverse events

“…Efforts to vary vascular access for different patient anatomies and those to appropriately dose antithrombotics may offer promise to address these disparities. Additionally, our finding that men have a greater adjusted risk of GU bleeding is supported by the known increased morbidity associated with foley catheters 26…”

Left atrial hypertension and the risk of early incident heart failure after atrial fibrillation ablation

“…In addition, based on previous data that acute hemodynamic changes affect clinical HF, we assumed a LAP difference of 5 mmHg in those with or without early incident HF (14 ± 6 vs. 9 mmHg), and with α = .05 and β = .80, a total of 104 patients was recommended (https://clincalc.com/stats/samplesize.aspx). 21 Because of the greater than expected rate of HF, the study was stopped at 100 subjects.…”

The use of distal femoral venous access for pulmonary vein cryoballoon ablation and left atrial appendage occluder implantation: randomized study design and preliminary results

“…Кроме того, периоперационная инфузионная поддержка часто приводит к перегрузке объемом, требует обеспечения удобных условий для эвакуации мочи, что диктует необходимость выполнения катетеризации мочевого пузыря, вызывающей опасения в фокусе осложнений в мужской группе [24]. Минимизация выполняемых катетеризаций может снизить риски развития мочеполовой инфекции и травматических повреждений мочевыводящих путей, а следовательно, уменьшить гематурию, дизурию, частоту стриктур мочеиспускательного канала [25].…”