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.