Safety and efficiency of same-day discharge after elective atrial fibrillation ablation: impact of vascular closure devices and ablation technique

Introduction

Same-day discharge (SDD) following atrial fibrillation (AF) ablation is an emerging strategy to improve patient experience and optimize healthcare resources. Despite its potential benefits, concerns regarding safety and applicability across different ablation technologies remain.

Purpose

To evaluate the safety and feasibility of SDD after elective AF ablation and assess the influence of vascular closure devices and ablation modality on discharge timing.

Methods

We conducted a single-center retrospective study of AF patients undergoing ablation between January 2023 and November 2025. Pulmonary vein isolation (PVI) was the primary strategy, complemented by cavo-tricuspid isthmus (CTI) ablation in patients with atrial flutter. SDD was considered after a minimum 4-hour observation period, provided patients met predefined criteria: hemodynamic stability, absence of immediate complications, and adequate home support. Outcomes included 30-day emergency readmissions and complication rates.

Results

A total of 462 patients were included (pulsed field ablation [PFA] 50.9%, cryoablation [CA] 47.2%, radiofrequency 1.9%). Acute PVI success was 99.3%, and CTI ablation was performed in 20% of cases. Mean procedure time was 75.7±35.8 min.

SDD was achieved in 69.6% of patients, reflecting 81.7% of the procedures ending before 4 pm. Thirty-day ER readmission rates were similar between SDD and overnight stay (ONS) groups (7.8% vs 12.5%, p=0.19), as were complication rates (0.4% vs 2.6%, p=0.07). SDD rates were comparable between PFA and CA (82.6% vs 80.6%, p=0.69). Vascular closure devices were used in 31.2% of cases, significantly reducing time to discharge compared to figure-of-eight suture (314 min vs 344 min, p=0.03).

Conclusion

SDD after elective AF ablation is safe and feasible with carefully selected patients, without increasing 30-day complications or readmissions. Vascular closure devices further shorten discharge time, and outcomes are consistent across PFA and CA techniques. These findings support broader implementation of SDD protocols, provided structured selection criteria is ensured.