Safety, feasibility and cost of outpatient radiofrequency catheter ablation of accessory atrioventricular connections.
OBJECTIVE
The purpose of this study was to evaluate prospectively the safety, feasibility and cost of performing radiofrequency catheter ablation of accessory atrioventricular (AV) connections on an outpatient basis in 137 cases.


BACKGROUND
The efficacy and low complication rate of radiofrequency ablation as performed in the hospital suggested that it might be feasible to perform it on an outpatient basis.


METHODS
In 100 cases (73%) performed between September 1, 1991 and April 20, 1992, patients met criteria for treatment as outpatients. Reasons for exclusion were age < 13 or > 70 years (4), anteroseptal location of the accessory AV connection (5 patients), obesity (> 30% of ideal body weight) (4 patients) or clinical indication for hospitalization (24 patients). Patients with only venous punctures had a recovery period of 3 h and those with arterial punctures had a recovery period of 6 h. There were 63 men and 32 women (5 patients underwent two ablation procedures > 1 month apart), with a mean age +/- SD of 36 +/- 13 years. The pathway was left-sided in 67 cases and right-sided or posteroseptal in 33.


RESULTS
The procedure was successful in 97 of 100 cases, with a mean procedure duration of 99 +/- 42 min. In 70 cases the patient was discharged the day of ablation, and in 30 cases the patient required a short (< or = 18-h) overnight stay because the procedure was completed too late in the day for recovery in the outpatient facility. The mean duration of observation was 4.8 +/- 1.5 h for outpatients and 15 +/- 1.4 h for patients who underwent overnight hospitalization. At follow-up study, two patients had a clinically significant complication; both had a femoral artery pseudoaneurysm detected > or = 1 week after the procedure and both required surgical repair. Thirty consecutive patients (22 outpatients and 8 hospitalized overnight) undergoing catheter ablation after January 1, 1992 were chosen for a cost analysis. The mean cost of the procedure was $10,183 +/- $1,082.


CONCLUSIONS
The majority of patients undergoing radiofrequency catheter ablation of an accessory AV connection can be treated safely on an outpatient basis.
Kalbfleisch
S J
SJ
Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 48109-0022.
el-Atassi
R
R
Calkins
H
H
Langberg
J J
JJ
Morady
F
F
D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000191:economics* / Q000592:standards; D001283:Atrioventricular Node / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000191:economics; D003365:Costs and Cost Analysis; D005240:Feasibility Studies; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008824:Michigan; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies; D012307:Risk Factors; D012449:Safety; D013997:Time Factors; D014927:Wolff-Parkinson-White Syndrome / Q000453:epidemiology / Q000601:surgery*