Impact of a standardised same-day discharge checklist on length of stay after pulsed-field atrial fibrillation ablation

Background Same-day discharge (SDD) after atrial fibrillation (AF) ablation can improve patient experience and reduce bed pressure, but evidence specific to pulsed-field ablation (PFA) pathways is limited. Purpose To evaluate the impact of implementing a standardised SDD checklist on length of stay and safety after PFA AF ablation in a single tertiary centre. Methods We retrospectively analysed 100 consecutive PFA AF ablations, comparing an early cohort before checklist implementation (n=50, March–December 2023) with a later cohort after introduction of a structured SDD checklist (n=50, June–September 2025). The checklist covered consultant review, haemodynamic and rhythm assessment, access-site and mobilisation checks, medication and follow-up planning, and patient education/safety-netting. The primary endpoint was SDD rate (discharge on the day of procedure); secondary endpoints were length of stay and acute procedural complications. Results Baseline characteristics were similar between cohorts (mean age 62 years, predominantly male). SDD increased from 50% (25/50) before checklist implementation to 84% (42/50) afterwards (χ²=11.6, p=0.0007). Median length of stay fell from 0.5 days (IQR 0–1) to 0 days (IQR 0–0). In the pre-checklist cohort, three patients (6%) experienced acute complications (one pericardial tamponade with subsequent permanent pacemaker implantation for long pauses, one coronary spasm, and one access-site bleed). No acute complications occurred in the post-checklist cohort. Conclusion Implementation of a simple, standardised SDD checklist for PFA AF ablation markedly increased SDD rates and reduced length of stay without an observed signal for increased early complications. Structured SDD pathways may help optimise resource utilisation as PFA volumes grow.