Same-day discharge after atrial fibrillation ablation: comparison of cryoablation versus radiofrequency catheter ablation

Abstract

Abstract Introduction Catheter ablation of atrial fibrillation (CA-AF) can be performed with same-day discharge (SDD). There is little comparative information on cryoablation (CRYO) vs. radiofrequency catheter ablation (RF) in this context. Objective To compare the results of CRYO versus RF in a systematic SDD programme. Methods From April 1, 2019, we established a systematic SDD program for all scheduled CA-AF procedures (n=617). We present the comparative analysis of CRYO (n=377) versus RF (n=240) cases. We defined a Primary Objective of Efficacy (PO-E: percentage of patients discharged on the same day in SDD-D), a Primary Objective of Safety (PO-S: cumulative incidence of urgent/unplanned care [U-UC] in the 10 days following discharge) and a Secondary Objective (Sec-O: average cost per procedure including day hospital stay, hospitalization and U-UC in the 10 days following discharge, using the most recent fees of the Spanish Public Health System). For the purpose of the Sec-O, the results of SDD program were compared with the procedures performed in the preceding year. Results PO-E: In 585/617 procedures (95%) the patient was discharged within 12 hours after the hospital arrival (range of length of hospital stay: 7-10 hours). There was no difference in the SDD rate between CRYO (356/377, 94%) vs. RF (229/240, 95%); p=0.6. Figure 1. Among patients who were hospitalized, there were no differences neither in the length of hospitalization nor in the average number of Hospital stays per patient: CRYO (32 hours [24-48], and 1 stay [1-2], respectively) vs. RF (34 [24-48] and 1 [1-2]); non-parametric p=0.9 for both comparisons. PO-S: 70 patients (11%) required U-CC within 10 days of discharge, the cumulative incidence being identical in both groups. Figure 2. There were no differences in the causes, with AF/fluter recurrence being the most frequent, originating half of them. Nine patients (1.5%), 6 after CRYO and 3 after RF, required U-CC the day after early discharge: 4 due to pericarditis (all CRYO), 4 due mild hematoma (2 CRYO and 2 RF) and 1 due to urticaria (CRYO). Only one patient underwent CRYO was hospitalized due to severe groin hematoma on day 3 after discharge. The remaining 69 patients with UUC were discharged within 8 hours of arrival at the Medical Center. Sec-O: The average cost per procedure was 562 euros (95% CI: 448-675), being similar in CRYO (582 [95% CI: 415-747]) vs. RF (530 [95% CI: 397-662]); (p=0.7). Compared to the previous year (n=100 procedures), both SDD groups were associated with a significant average savings of 1156 (CRYO) and 1208 (RF) euros (p<0.001 for both). Conclusions 1-CA-AF can be performed with less than 12 hours of hospital stay in 95% of patients, with similar frequency in CRYO vs. RF. 2-SDD is associated with a low rate of U-UC (11%), whose causes, incidence and timing are similar in CRYO vs. RF. 3-SDD after CRYO and RF leds to a significant reduction in cost per procedure.Causes of hospitalizationKaplan-Meier graph for U-UC