Impact on nurse workload and patient satisfaction of atrioventricular junction ablation performed simultaneously with conduction system pacing using a superior approach from the pocket compared with the conventional femoral approach

Author:

Palmisano Pietro1ORCID,Sergi Cesario1,Panico Vincenzo1,Chiarillo Marco Valerio1,Chiuri Maria Domenica1,Martella Maria Lucia1,Stefanelli Gianluca1,Martella Deborah1,Mauro Raffaele1,Ponzetta Maria Antonietta1,Parlavecchio Antonio12,Accogli Michele1,Coluccia Giovanni1

Affiliation:

1. Cardiology Unit, ‘Card. G. Panico’ Hospital , Via S. Pio X, 4, 73039 Tricase , Italy

2. Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina , Piazza Pugliatti, 1, 98122 Messina , Italy

Abstract

Abstract Aims Conduction system pacing (CSP) and atrioventricular junction ablation (AVJA) improve outcomes in patients with symptomatic, refractory atrial fibrillation (AF). Superior approach (SA) from the pocket, via the axillary or subclavian vein, has been recently proposed as an alternative to the conventional femoral access (FA) to perform AVJA. In this study, we compare the impact of these alternative approaches on nurse workload (NWL) and patient satisfaction. Methods and results This was a prospective, observational study enrolling consecutive patients undergoing simultaneous CSP and AVJA. Electrophysiology laboratory (EP Lab) NWL was calculated by using a self-developed model. Ward NWL was calculated using the MIDENF® validated scale. Patient satisfaction was collected using the Hospital Consumer Assessment of Healthcare Provider Systems questionnaire. A total of 119 patients were enrolled: in 50, AVJA was primarily attempted with SA, and in 69 with FA. Compared with FA, SA was associated with a lower EP Lab NWL (169.8 ± 26.7 vs. 202.7 ± 38.9 min; P < 0.001) and a lower Ward NWL (474.5 ± 184.8 vs. 808.6 ± 289.9 min; P < 0.001). Multivariate analysis identified SA as an independent predictor of lower EP Lab NWL [hazard ratio (HR) 4.60; P = 0.001] and of lower Ward NWL (HR 45.13; P < 0.001). Compared with FA, SA was associated with a higher patient-reported rating regarding their experience during hospital stay (P = 0.035) and the overall hospital evaluation (P = 0.026). Conclusion In patients undergoing simultaneous CSP and AVJA, the use of an SA for ablation is a valid alternative to conventional FA. Compared with FA, this approach significantly reduces NWL and is associated with greater patient satisfaction. Registration ClinicalTrials.gov: NCT03612635

Publisher

Oxford University Press (OUP)

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