Patient Selection for a SDD Protocol
Differences in the baseline characteristics of SDD patients versus ONS
patients were observed; SDD patients were younger and tended to have
fewer comorbidities than the ONS cohort. One possible reason for these
differences is the operator likely selected younger patients with fewer
comorbidities and lower CHA2DS2-VASc
score for SDD. Each facilities SDD protocol was structured to exclude
higher risk patients in whom there is a higher propensity for
complication. Further, patients were only eligible for SDD if they had
an uncomplicated cryoballoon ablation procedure. Overall, patient
selection for SDD at the three geographically diverse hospitals relied
upon similar criteria, with some key differences. Specifically, similar
criteria for systolic blood pressure, heart rate, oxygen saturation, and
mental status existed at each site. Residential location requirements
varied by center. No specification for a patient’s residential location
existed for patients treated at the West Coast hospital, while patients
were required to live ≤30 min or <75 miles from the East Coast
and Midwest hospitals, respectively. Similar ambulatory and hemodynamic
requirements for SDD eligibility following cryoballoon ablation existed
at the hospitals.
Two previous studies evaluated the safety and feasibility of same day
discharge for patients who underwent AF ablation. Both studies were
single center with a small number of patients. Haegeli et al.included 230 patients who underwent radiofrequency ablation and reported
no late peripheral or cerebral thromboembolic events.9Bartoletti, et al. reported a single center study that included
169 patients who underwent cryoballoon and radiofrequency AF ablation
and were discharged home the same day.10 The study
compared SDD cohort to 642 patients who stayed overnight and found no
difference in complication rates.10 The SDD cohort in
this study was compared to historical controls who were monitored
overnight following cryoballoon ablation procedure. A better
understanding of patient criteria is essential for defining candidates
for SDD and standardization of procedural adaptations implemented to
enable earlier discharge may improve how SSD can be safely performed
across a large group of patients. For example screening and scheduling
candidates for SDD as an earlier case in the day is a simple policy step
that would allow a SDD strategy succeed.