Same‐day discharge after cryoballoon ablation of atrial fibrillation: A multicenter experience

Marcin Kowalski; Valay Parikh; Jose Rios Salcido; Nagib Chalfoun; Alfred Albano; Padraig Gearoid O’Neill; Mark R. Bowers; Andre Gauri; Kendra M. Braegelmann; Hae W. Lim; Philippe Akhrass; Rina Shah; Soad Bekheit; Laurence M. Epstein; Arash Aryana

doi:10.1111/jce.14843

December 21, 2020Journal of Cardiovascular Electrophysiology

Same‐day discharge after cryoballoon ablation of atrial fibrillation: A multicenter experience

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Why the study?

Overnight stay is common practice following catheter ablation for AF, but the safety and economic impact of same-day discharge after cryoballoon ablation had not been evaluated across high-volume US centers.

Does a same-day discharge protocol safely reduce costs compared to an overnight stay in patients undergoing cryoballoon ablation for atrial fibrillation?

Structured PICO

Does a same-day discharge protocol safely reduce costs compared to an overnight stay in patients undergoing cryoballoon ablation for atrial fibrillation?

P

Population

2,374 consecutive patients who underwent cryoballoon ablation for atrial fibrillation at three US centers

I

Intervention

Same-day discharge (SDD) protocol

C

Comparator

Overnight stay (ONS)

O

Outcome

30-day total complication rate and hospital cost savingssafety

Same-day discharge after cryoballoon ablation for atrial fibrillation appears safe and is associated with significant hospital cost savings compared to routine overnight observation.

Implication

Supports same-day discharge feasibility after cryoballoon ablation; leaves open randomized confirmation of safety and cost savings.

Abstract

BACKGROUND: It is common practice to observe patients during an overnight stay (ONS) following a catheter ablation procedure for the treatment of atrial fibrillation (AF). OBJECTIVES: To investigate the safety and economic impact of a same-day discharge (SDD) protocol after cryoballoon ablation for treatment of AF in high-volume, geographically diverse US hospitals. METHODS: We retrospectively reviewed 2374 consecutive patients (1119 SDD and 1180 ONS) who underwent cryoballoon ablation for AF at three US centers. Baseline characteristics, acute procedure-related complications, and longer-term evaluations of safety were recorded during routine clinical follow-up. The mean cost of an ONS was used in a one-way sensitivity analysis to evaluate yearly cost savings as a function of the percentage of SDD cases per year. RESULTS: -VASc scores (1.4 ± 1.0 vs. 2.2 ± 1.4; p < .0002). There was no difference between SDD and ONS in the 30-day total complication rate (n = 15 [1.26%] versus n = 24 [2.03%]; p = .136, respectively). The most common complication was hematoma in both the SDD (n = 8; 0.67%) and ONS (n = 11; 0.93%) cohorts. Sensitivity analysis demonstrated that when 50% of every 100 patients treated were discharged the same day, hospital cost savings ranged from $45 825 to $83 813 per year across US hospitals. CONCLUSIONS: SDD following cryoballoon ablation for AF appears to be safe and is associated with cost savings across different US hospitals.