Discussion:
The COVID-19 global pandemic continues regional resurgence despite
containment efforts. Following the initial peak of local infection in
New York City, as healthcare resource availability allowed resumption of
non-emergent procedures, we instituted measures to ensure patient and
hospital staff safety while reducing healthcare resource utilization.
Our key COVID-19 pandemic related interventions included: 1) COVID-19
nasal PCR testing for all electrophysiology lab staff, and for all
patients within 72 hours prior to a scheduled ablation procedure, 2)
Reducing pre-procedure TEE utilization, 3) Utilization of a venous
closure device to facilitate early ambulation and same-day discharge, 4)
staged re-introduction of limited visitors with monitoring for
appropriate PPE.
The main findings of our reboot of AF ablation in the setting of
significant local COVID-19 prevalence are: 1) Zero new COVID-19
infections in patients 30 days post ablation, 2) Zero cases of new
COVID-19 infections amongst electrophysiology lab staff, 3) Same day
discharge achieved in 68% of patients in the 2020 cohort, compared to
0% of patients in the 2019 cohort, 4) Significantly reduced median
duration of hospitalization in the 2020 cohort compared to the 2019
cohort (12h vs. 29h, p<0.001, respectively), 5) Significantly
reduced utilization of pre-procedure TEE in the 2020 cohort compared to
the 2019 cohort (68.4% vs. 97.5%, p <0.001, respectively)
despite greater prevalence of persistent arrhythmia in the 2020 cohort.
In contrast to prior reports of same-day discharge after AF ablation,
all patients in our 2020 cohort underwent radiofrequency ablation under
general anesthesia with high-frequency jet ventilation. Additionally,
2020 cohort patients had a higher prevalence of comorbidities including
stroke/TIA, and persistent atrial arrhythmias when compared to patients
in the 2019 cohort. Despite these patient characteristics and
accelerated post-ablation discharge, there was no significant difference
in the procedure related complications between cohorts. The advantage of
same day discharge was two-fold. First, this reduced the probability of
patients’ COVID-19 exposure and second, it reduced the need for
overnight observation beds which could be potentially utilized for
patients with acute illnesses during the pandemic.