Same day discharge following pulsed field ablation for atrial fibrillation: a meta-analysis

Backgrounds

Same-day discharge (SDD) after atrial fibrillation (AF) ablation aims to improve healthcare efficiency, cut hospital costs, and shorten wait times, enhancing patient satisfaction. However, data on SDD with pulsed field ablation (PFA), especially with new integrated systems, are limited.

Purpose

This meta-analysis was conducted to evaluate the safety and effectiveness of SDD compared with overnight stay (OS) following PFA.

Methods

A systematic search of PubMed, Embase, and Cochrane databases was conducted to identify randomised controlled trials or observational studies comparing SDD with OS in patients who underwent PFA for 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

Four studies with 2599 patients (36.5% female, mean age 67.5 ± 10.6 years, 49.1% paroxysmal AF) were included, comprising 1561 SDD vs 1038 OS group cases. The median follow-up period was 8 months (range 3-12 months), with the pentaspline catheter as the most frequently used PFA technology (84.9%).

SDD was not associated with an increased rate of major adverse events (RR 0.18; 95% CI: 0.03 – 1.30; I² = 57%) or vascular complications (RR 0.08; 95% CI: 0.00 – 9.19; I² = 40%) compared with OS (Figure 1). 30-day all-cause readmission rates showed no significant difference between the two strategies (RR 0.85; 95% CI: 0.24 – 3.00; I² = 0%) (Figure 2). No deaths were reported following the procedure or within the first 30 days.

Conclusion

These findings support the idea that SDD after PFA ablation for AF is safe and feasible. Randomized controlled trials are required to confirm these findings and establish definitive conclusions.