Safety of SDD following Cryoballoon Ablation
SDD has been previously evaluated in other sections of cardiology and demonstrated cost benefits.2 Importantly, in any SDD procedure, the rate of intraprocedural and post-procedural complications must remain low for patient safety and economic benefit(s). In this analysis, the complication rate in SDD and ONS cohorts was not different from each other and comparable to previous reports. A systematic review of 192 studies by Gupta et al . determined the overall incidence of complications associated with catheter ablation of AF was 2.9%,11 which is similar to the rate of patients who stayed overnight in this analysis. The systematic review did not mention the method of discharge in the literature search; however, given the fact that it included all studies prior to 2012, it is likely that most of these patients were kept overnight.11 A worldwide survey on safety of AF ablation agnostic of ablation modality collected from 182 centers reported a slightly higher complication rate of 4.5%.12 The reasons for higher rate in the global survey may include that it incorporated earlier catheter technology and techniques and centers with a wide range of volume and experience. By contrast, this study included patients from three high volume centers with experienced operators. The overall complication rate in the SDD group was numerically lower than the ONS group. This might be explained by a selection bias by the operator. As represented in the baseline characteristics, the operators most likely chose younger and healthier patients to be discharged the same day while patients with more comorbidities where observed overnight following the cryoballoon ablation.
Hematoma or vascular complication were the most common complication observed in our study, consistent with other reports.1, 11, 12 The rate of hematoma has been reported between 1.2-1.4%; however, the rate of hematoma in our study was slightly lower at 0.67-0.93%. Ultrasound guidance to obtain vascular access may have contributed to the low rate of vascular complications in our trial.13 The risk of stroke in previous studies has been reported between 0.23-0.30%, which is slightly higher than observed in our study.11, 12 Uninterrupted anticoagulation with warfarin or DOAC facilitated early ambulation on continued anticoagulation, which may have contributed to a low risk of stroke complications. Most pericardial effusion and tamponade events generally occur during the procedure or are observed immediately after the procedure.1 In our study, all transseptal punctures were performed under intracardiac echocardiographic guidance. The presence or absence of pericardial effusion was examined via imaging (e.g. fluoroscopy and ultrasound) both during the case and after the catheter ablation procedure. Furthermore, due to serious consequences of these complications, some of the participating centers performed a transthoracic echocardiogram before discharge. These additional precautions may safeguard against undetected pericardial complications in the SDD population.