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 to the conventional femoral approach

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 axillary or subclavian vein, has been recently proposed as an alternative to the conventional femoral venous approach (FA) to perform AVJA. In this study we compared the impact of these alternative approaches on the nurse workload (NWL) and on patient satisfaction.

Methods and results: Prospective, observational study, enrolling consecutive patients undergoing simultaneous CSP and AVJA. ElectrophysiologyLaboratory (EP Lab) NWL was calculated with 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 (HCAHPS) questionnaire. A total of 119 patients were enrolled: in 50, AVJA was primarily attempted with SA, in 69 from FA. Compared to FA, SA was associated with a lower EP Lab NWL (169.8±26.7 vs. 202.7±38.9 minutes; p<0.001), and a lower Ward NWL (474.5±184.8 vs. 808.6±289.9 minutes; p<0.001). Multivariate analysis identified SA as an independent predictor of lower EP Lab NWL (hazard ratio 4.60; p=0.001), and of lower Ward NWL (hazard ratio 45.13; p<0.001). Compared to FA, SA was associated with a higher patient-reported rating regarding the experience during hospital stay (p=0.035), and the overall hospital evaluation (p=0.026).

Conclusions: In patients undergoing simultaneous CSP and AVJA, the use of a SA for ablation is a valid alternative to conventional FA. Compared to FA, this approach significantly reduces NWL, and is associated with greater patient satisfaction.

Keywords: AV junction ablation; His bundle pacing; ablate and pace; atrial fibrillation; catheter ablation; conduction system pacing; left bundle branch area pacing; nurse workload; patient experience; patient satisfaction.