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.