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

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 The SDD and ONS cohorts were predominately male (69% vs. 67%; p = .3), but SDD patients were younger (64 +/- 11 vs. 66 +/- 10; p < .0001) with lower body mass index (30 +/- 6 vs. 31 +/- 61; p < .0001) and CHA(2)DS(2)-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.