Safety of same-day discharge following pulsed field vs. thermal ablation for atrial fibrillation: a meta-analysis

Background

Same-day discharge (SDD) after atrial fibrillation (AF) ablation is increasingly adopted to optimise healthcare resource utilisation without compromising safety. While established SDD protocols are largely based on thermal energy sources, pulsed-field ablation (PFA) may further streamline workflows due to shorter procedure times and a favourable safety profile. However, large-scale comparative data on energy modalities within SDD programmes remain limited.

Purpose

To perform a meta-analysis comparing the safety of PFA versus thermal ablation for AF ablation within established SDD protocols.

Methods

A systematic search of PubMed, Embase, and Cochrane databases was conducted to identify randomised controlled trials or observational studies comparing PFA with radiofrequency/cryoballon in SDD patients who underwent AF ablation. The primary endpoint was a composite of major adverse events within 30 days. Risk ratios (RR) with 95% confidence intervals (CI) were calculated using a random-effects model with the Hartung-Knapp-Sidik-Jonkman method.

Results

Three studies, including 1011 patients (402 PFA, 609 thermal), were included. In the PFA group, 77.5% of procedures were performed with the pentaspline catheter. In the thermal group, radiofrequency was performed in 43% of cases.

SDD after PFA was not linked to an increased rate of major adverse events (RR 3.32; 95% CI: 0.63 – 17.55; I² = 0%) or all-cause mortality (RR 1.40; 95% CI: 0.15 – 13.40; I² = 0%) within 30 days compared to thermal ablation (Figure 1). The 30-day all-cause readmission rate showed no significant difference (RR 2.32; 95% CI: 0.44 – 12.30; I² = 51%) (Figure 2).

Conclusion

In patients undergoing PFA, SDD demonstrated a safety profile comparable to that observed after thermal ablation for AF and may further enhance procedural workflow efficiency. However, randomized controlled trials are required to confirm these findings and establish definitive conclusions.