Safety and feasibility of same-day discharge versus overnight stay in electrophysiology procedures: initial German experience

Background

Catheter ablation is a well-established therapy for cardiac arrhythmias. As the incidence of atrial fibrillation (AF) continues to rise, the associated healthcare burden is expected to increase. Same-day discharge (SDD) protocols may optimize resource utilization. Even though SDD is increasingly implemented, inpatient management remains the standard of care in most European countries, including Germany.

Purpose

To evaluate the safety and efficacy of SDD versus overnight stay (ONS) electrophysiological (EP) procedures.

Methods

Consecutive patients undergoing EP procedures were prospectively enrolled under an SDD protocol and compared with consecutive ONS patients, matched by procedure type. SDD patients were discharged on the procedure day after successful ambulation. Eligibility criteria included age <85 years, no severe comorbidities, BMI <40 kg/m², residence ≤50 km, and an accompanying person. All patients had ultrasound-guided femoral access. A follow-up visit for groin inspection and pericardial effusion screening was performed on day 1. ONS patients remained hospitalized for at least one night and underwent identical postprocedural evaluations. Baseline, procedural, and 30-day follow-up data regarding emergency department (ED) visits, unplanned presentations, and readmissions were compared between groups. Groin complications included all documented venous bleedings, hematomas, pseudoaneurysms, arteriovenous fistulas, thromboses, nerve injuries and infections.

Results

Between September 2022 and February 2025, 100 patients underwent SDD EP procedures and were compared with 100 patients treated under an ONS protocol. Patients in the SDD group were younger, less often female, and had a higher BMI. Coronary artery disease and chronic kidney disease were less frequent in the SDD group (Table 1).

Procedures included AF (n=76), AVNRT (n=13), CTI (n=3), AVRT (n=2), PVC ablation (n=2), and LAA occluder implantation (n=4) in each group.

Vascular closure systems were used more frequently in the SDD group (42% vs. 28%; p=0.054). Procedural complications occurred in 2% vs. 6% (p=0.279) of patients. Complications until discharge (including the day 1 visit for the SDD group) were reported in 9% vs. 17% (p=0.140) of SDD and ONS patients, respectively. Complications identified at the day 1 occurred in 7% of SDD patients, no one requiring hospitalisation. The median time to discharge in the SDD group was 5 h 27 min (4 h 49 min - 6 h 17 min).

ED presentations within 30 days were reported in 6% vs. 5% (p=1.0) of SDD and ONS patients. Unplanned ambulatory visits (7% vs. 2%; p=0.170) and readmissions (4% vs. 1%; p=0.369) were comparable (Table 2).

Conclusions

In this prospective study, SDD after EP procedures proved to be a safe alternative to ONS. No SDD cases required hospitalization on day 1. Although SDD patients were younger and had fewer comorbidities, the results strongly support SDD as a feasible and safe strategy for carefully selected patients.Figure 1Figure 2