Hi, my name is Amin Al-Ahmad from Texas Cardiac Arrhythmia in Austin, Texas, and I'd like to talk to you today about same-day discharge for atrial fibrillation ablation patients. This is becoming a more important topic nowadays due to the COVID-19 global pandemic, in particular since patients typically don't want to spend the night in the hospital, and many patients would like to spend as short a period of time in the hospital as possible. There are several things to consider when thinking about same-day discharge for atrial fibrillation. So, first of all, performing the procedure, thinking ahead, trying to minimize all complications. For example, obtaining access using groin ultrasound. That's an important way, especially since groin complications are the most common complications with atrial fibrillation ablation. Second, after finishing the ablation, examining the heart with intracardiac echo to ensure that there's no developing effusions, as that may also delay discharge for the patients. And then lastly, in some patients who receive an excessive amount of fluid due to extensive ablation, they may not be great candidates for same-day discharge, so evaluating the amount of fluid that these patients get. Another consideration in these patients is early ambulation and short bed rest, in particular since you want to make sure these patients can get up and move around before discharge from the hospital. So, at our center, at least, we typically will use a closure device to close the venous puncture site in all of our patients, and that allows for a one- to two-hour bed rest prior to ambulation, make sure the patient can ambulate, and that also leads us to an earlier discharge time. Another major consideration is teaching and follow-up, and so typically for our normal patients, they receive teaching on the day after the ablation. This is done with a dedicated nurse whose job is to teach the patients, so this has to be now done on the same day, so it needs to be coordinated so that the nurse educator or whoever it is that's going to educate the patient and the family has to be there after the procedure. And so, typically, you want to have these as early procedures to ensure that there's enough time for the nurse educator to get there, or whoever it is that's going to educate the patient to get there and make sure that the family is present at the same time. And also, setting up a monitoring and setting up follow-up at that time is important as well. If you're considering doing same-day discharge, one way to start doing this is in low-risk patients, and so, for example, paroxysmal patients, particularly those who have a low CHADS-VASc score, those, by definition, have very few comorbid conditions, and they may be really good ways to enter into the world of same-day discharge. You can schedule these to be your first cases of the day, so that they're early. Use a closure device, make sure the patients can ambulate, and if the patients didn't receive a lot of IV fluid, then those patients may be perfect candidates for same-day discharge. I hope this is a helpful video, and please contact me, feel free to contact me if you have any questions. Thank you.

same-day discharge

complications

fluid assessment

early ambulation

closure devices