Introduction:
Coronavirus disease 2019 (COVID-19) resulted in curtailment of
non-emergent medical care in order to limit exposure to patients and
healthcare workers and preserve limited personal protective equipment
(PPE) 1. Meeting the challenges of peak COVID-19
infection resulted in reassignment of hospital beds and repurposing of
personnel throughout the United States. Electrophysiology programs like
ours, in accordance with recommendations collectively provided by
professional societies1,2 and local regulations
prioritized urgent electrophysiological procedures during periods of
high healthcare utilization related to COVID-193.
These efforts have helped to minimize patient and health care
professional exposure by postponement of elective cases and careful
management of urgent or otherwise time-sensitive conditions.
As local COVID-19 cases ebb and healthcare resource availability is less
constrained, uncertainty remains regarding best practices for
re-initiating less urgent procedures. In addition, there has been
increasing recognition of morbidity and mortality associated with delays
in cardiac care, including arrhythmia procedures such as ablation for
those with severe symptoms from atrial fibrillation (AF) or atrial
flutter4.
Catheter ablation of AF is most frequently performed with overnight
post-procedure monitoring. Rhythm control via cardioversion or catheter
ablation is an important means of reducing AF related
hospitalization5. The limited prior literature
regarding the safety of same-day discharge following AF ablation has
included procedures performed under conscious
sedation6, using Cryoballoon technology, and/or with 4
hour post-procedure bed-rest6. A minority of patients
were discharged on the day of catheter ablation in a recent study
reporting outcomes of same-day discharge following radiofrequency
ablation of AF under general anesthesia7. We sought to
implement policies and procedures to ensure safety of patients and
healthcare workers, while reducing utilization of healthcare resources
and maintaining quality of care for AF ablation performed under general
anesthesia with high-frequency jet ventilation. We systematically
evaluated acute and subacute outcomes of these interventions as a
quality initiative.