Determinants and clinical implications of discharge timing after catheter ablation for atrial tachycardia

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Abstract Aims Early discharge after electrophysiological procedures has gained increasing attention. However, definition of patient- and procedure-related prerequisites for successful and safe discharge strategies after atrial tachycardia (AT) ablation remains unknown. We therefore evaluated patient characteristics, procedural features, and outcomes according to index length of stay (LOS) following AT ablation. Methods and results The multicenter observational SATELLITE registry enrolled consecutive patients undergoing AT rhythm control. Patients were stratified by LOS (≤1, 2 and >2 nights) after catheter ablation. Among 670 patients (67 [IQR 56–75] years, 54.9% male), LOS was ≤1 night in 13.9%, 2 nights in 41.9% and >2 nights in 44.2%. LOS was only modestly predictable from clinical characteristics including age, sex, atrial fibrillation and prior atrial ablation (AUC 0.73). Discrimination improved after inclusion of procedural variables and early post-procedural events (AUC 0.77; P =0.0300), consistent with an increase in left atrial procedures (26.5% vs. 76.0% vs. 80.8%; P <0.0001), acute minor complications (3.2% vs. 2.5% vs. 14.5%; P <0.0001) and early recurrences of atrial arrhythmia (2.2% vs. 6.8% vs. 21.3%; P <0.0001). During 2.8±3.0 years of follow-up, LOS did not predict long-term outcomes including subsequent cardiovascular hospitalization (HR 1.19, 95% CI 0.78–1.81; P =0.4175). Conclusion Despite multiple comorbidities, most patients undergoing AT ablation need up to 2 nights of hospitalization. However, prolonged hospital stays before successful and safe discharge are common and associated with acute minor complications and early recurrences of atrial arrhythmia rather than comorbidities. Accordingly, discharge timing largely reflects the immediate peri-procedural clinical course, therefore challenging purely logistics-driven planning. Key Learning Points What is already known Early discharge after electrophysiological procedures has gained increasing attention. Definition of patient- and procedure-related prerequisites for successful and safe discharge strategies after atrial tachycardia (AT) ablation remains unknown. What this study adds Despite multiple comorbidities, most patients undergoing AT ablation need up to 2 nights of hospitalization. Prolonged hospital stays before successful and safe discharge are common and associated with acute minor complications and early recurrences of atrial arrhythmia rather than comorbidities. Discharge timing largely reflects the immediate peri-procedural clinical course, therefore challenging purely logistics-driven planning Structured Graphical Abstract Despite multiple comorbidities, most patients undergoing AT ablation need up to 2 nights of hospitalization. However, prolonged hospital stays before successful and safe discharge are common and associated with acute minor complications and early recurrences of atrial arrhythmia rather than comorbidities. Accordingly, discharge timing largely reflects the immediate peri-procedural clinical course, therefore challenging purely logistics-driven planning.

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