Vascular Closure Strategies in Pulmonary Vein Isolation to Reduce Vascular Complications and Facilitate Same Day Discharge

Background Minor access-site bleeding is common after pulmonary vein isolation (PVI) for atrial fibrillation (AF). Vascular closure devices (VCDs) may reduce bleeding, facilitating shorter bedrest and same-day discharge (SDD). Objective This study assessed the impact of closure strategies (Perclose™ ProStyle™ (VCD) and figure-of-eight (FO8)-suture) and mobilization protocols on access-site bleeding complications and length of hospital stay. Methods This single-center observational study included patients undergoing a primary PVI for AF between January 15 th and December 31 st , 2025, at the St. Antonius Hospital, the Netherlands. Four protocols were evaluated sequentially: cohort 1: FO8-suture + 4h bedrest; cohort 2: VCD + 4h bedrest; cohort 3: VCD + 2h bedrest + 2h seated; cohort 4: VCD + FO8-suture + 2h bedrest + 1h seated. Primary outcome was in-hospital access-site bleeding, categorized by intervention. Secondary outcomes included SDD, time to discharge (TTD), unplanned overnight stay (ONS) and emergency room (ER) visits due to groin complications. Results A total of 738 patients were included (cohort 1-4: n=170/ 161/ 210/ 197). Baseline characteristics were comparable. Two major bleeding complications occurred in cohort 1. Minor bleeding complications decreased across the four cohorts from 19.4% to 9.6% (p=0.027). Female sex (OR 1.52), protamine use (OR 0.50) and cohort 4 protocol (OR 0.38) predicted bleeding. SDD increased from 56.5% (cohort 1) to 67.0% (cohort 4, p=0.168), without more unplanned ONS or bleeding-related ER visits. Conclusion The use of a VCD in combination with a FO8-suture and protamine use was significantly associated with lower observed access-site bleeding complications and optimized the workflow of PVI.