背景:尽管它们的安全性得到了提高,大多数心脏电生理学程序,包括导管消融(CA),目前在医院门诊部(HOD)进行。
目标:这个大,多中心研究调查了在6个门诊手术中心(ASC)进行的各种心脏电生理程序的安全性和结果,主要是在CMS无墙医院计划下的COVID-19大流行期间。
方法:我们回顾性分析了在当天出院的ASCs中进行的连续电生理检查的结果,包括经食管超声心动图(TEE),心脏复律,心脏可植入电子设备(CIED)植入,电生理学研究(EPS),和CA用于心房颤动(AF),房扑(AFL)/室上性心动过速(SVT),室性早搏(VPC),和AV节点。
结果:总之,进行了4,037次手术,包括779例TEE/心脏复律(19.3%),1,453CIED植入物(36.0%),26每股收益(0.6%),房颤(75.4%)和1,779个CA(44.1%),AFL/SVT(18.8%),VPC(4.7%),和AV节点(1.1%)。总的来说,80.2%的CA用于需要经中隔导管插入的左侧房性心律失常(AF/非典型AFL)。使用经中隔/逆行入路进行左侧VPC消融(42.2%)。不良事件发生率很低,但CIED和CA之间具有可比性(0.76%与0.73%;P=0.93),手术后紧急/非计划住院的发生率(0.48%vs.0.45%;P=0.89),分别。此外,ASCs与HOD的不良事件发生率与CIED没有差异(0.76%与0.65%;P=0.71)或CA(0.73%vs.0.80%;P=0.79)。
结论:这个大的结果,多中心研究表明,ASCs代表了一种安全有效的环境,可以进行包括CA在内的各种心脏电生理程序。这些发现对医疗保健服务和政策具有重要意义。
BACKGROUND: Despite their improved safety, a majority of cardiac electrophysiology procedures, including catheter ablation (CA), are presently performed in hospital outpatient departments.
OBJECTIVE: This large multicenter study investigated the safety and outcomes associated with various cardiac electrophysiology procedures performed at 6 ambulatory surgery centers (ASCs), primarily during the coronavirus disease 2019 pandemic under the Center for Medicare and Medicaid Services Hospitals Without Walls program.
METHODS: We retrospectively analyzed the outcomes from consecutive electrophysiology procedures performed in ASCs with same-day discharge, including transesophageal echocardiography, cardioversion, cardiac implantable electronic device (CIED) implantation, electrophysiology studies, and CA for atrial fibrillation (AF), atrial flutter (AFL)/supraventricular tachycardia, ventricular premature complexes (VPCs), and atrioventricular node.
RESULTS: Altogether, 4037 procedures were performed, including 779 transesophageal echocardiography/cardioversion procedures (19.3%), 1453 CIED implantation procedures (36.0%), 26 electrophysiology studies (0.6%), and 1779 CA procedures (44.1%) for AF (75.4%), AFL/supraventricular tachycardia (18.8%), VPC (4.7%), and atrioventricular node (1.1%). Overall, 80.2% of CA procedures were for left-sided atrial arrhythmias (AF/atypical AFL) requiring transseptal catheterization. Left-sided VPC ablation procedures (42.2%) were performed using a transseptal/retrograde approach. Adverse event rates were low, but comparable between CIED and CA (0.76% vs 0.73%; P = .93), as were the incidences of urgent/unplanned postprocedure hospitalization (0.48% vs 0.45%; P = .89), respectively. Moreover, the adverse event rates in ASCs vs hospital outpatient departments did not differ for CIED (0.76% vs 0.65%; P = .71) or CA (0.73% vs 0.80%; P = .79).
CONCLUSIONS: The results from this large multicenter study suggest that ASCs represent a safe and effective setting to perform a variety of cardiac electrophysiology procedures including CA. These findings bear important implications for health care delivery and policy.