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.