Patient and Procedural Factors Associated With Same-Day Discharge Following Pulsed Field Ablation for Atrial Fibrillation: Insights From the DISRUPT-AF Registry.

BACKGROUND

Same-day discharge (SDD) after catheter ablation for atrial fibrillation (AF) may improve patient satisfaction and optimize healthcare resources. Pulsed field ablation (PFA) offers a favorable safety profile, potentially enabling broader adoption of SDD strategies.

OBJECTIVE

To evaluate site-level practice patterns and participant- and procedure-related factors associated with SDD after de novo PFA for AF.

METHODS

We analyzed data from participants in the DISRUPT-AF registry, a prospective, multicenter study evaluating ablation acute outcomes with a pentaspline PFA catheter. We examined participant and procedure characteristics associated with both SDD planning and success.

RESULTS

SDD was preplanned for 81% (1203) of all cases; 93% (1118) of those preplanned were successful. Acute procedural complication rates were low across discharge strategies (0.7% SDD planned vs. 0.7% not planned, p = 0.956). SDD planning was associated with shorter procedure time (60.6 vs. 66.8 min, p < 0.001), fewer procedures starting after 2 p.m. (p < 0.001), and fewer adjunctive ablations beyond pulmonary vein isolation (PVI) (p < 0.001). Unsuccessful SDD was associated with prior stroke/transient ischemic attack (TIA) (16.0% vs. 5.9%, p < 0.001), higher CHA₂DS₂-VASc score (p = 0.001), lower left ventricular ejection fraction (p = 0.031), later procedure start (p < 0.001), and higher acute complication rates (7.1% vs. 0.3%, p < 0.001).

CONCLUSION

In this large multicenter registry, SDD after PFA was widely adopted, safe, and successful in most planned cases. Unsuccessful SDD was strongly associated with acute complications and comorbid conditions, underscoring the need for careful candidate selection to optimize safety and efficiency.

CLINICAL TRIAL REGISTRATION: Trial Registration: NCT06335082.