Safety, effectiveness and healthcare resource implications of an early discharge pathway for cryoballoon ablation: real-world evidence from China

Introduction Same-day discharge after atrial fibrillation (AF) ablation has been increasingly adopted in Western healthcare systems. However, its applicability in China remains uncertain because of differences in healthcare delivery, peri-procedural management, and hospitalization practices. Meanwhile, real-world evidence on early discharge pathways for AF ablation in the Chinese setting remains limited. This study evaluated the clinical and economic outcomes of an early discharge pathway for patients undergoing cryoballoon ablation in China. Methods A retrospective real-world study was conducted using data from the institutional atrial fibrillation database at Fuzhou University Affiliated Provincial Hospital. Consecutive patients who underwent cryoballoon ablation between January 2021 and December 2023 were included. Patients were stratified into two cohorts based on post-operative length of stay: the early discharge (ED) group (discharged within 48 h) and the conventional inpatient (CI) group (discharged after 48 h). Propensity score matching was performed to minimize baseline imbalances between groups. The outcomes were atrial fibrillation recurrence, post-procedural complications and hospitalization cost. Results A total of 327 patients were included in the final analysis, with 151 in the ED group and 176 in the CI group. After 1:1 propensity score matching, 80 patients remained in each group, and baseline comparability was substantially improved after matching, although a small residual imbalance remained for stroke/TIA history. During 12 months of follow-up, the recurrence rate of AF was similar between the two groups (8.75% vs. 10.00%, P = 0.786). No major in-hospital complications occurred in the ED group, whereas one case of pericardial effusion was reported in the CI group. Subgroup analyses showed no significant difference in recurrence among patients aged 65 years or older or among those with persistent atrial fibrillation. The ED group incurred significantly lower medical service costs ( P = 0.0003) and medication costs ( P = 0.035) than the CI group. However, no significant difference was observed in total hospitalization costs between the two groups ( P = 0.957). Discussion In this real-world Chinese cohort, a structured early discharge pathway for cryoballoon ablation appeared to be feasible and was not associated with a higher AF recurrence rate, while reducing medical service-related costs. However, because this was a retrospective single-center study with a limited sample size and no systematic post-discharge surveillance for all potential events, these findings should be interpreted with caution. Larger prospective studies are needed to further confirm the safety, effectiveness, and economic implications of this model.