Procedural characteristics and clinical outcomes from same-day discharge after pulsed field ablation treatment for atrial fibrillation: an admIRE trial sub-analysis

AIMS: Same-day discharge (SDD) following catheter ablation for atrial fibrillation (AF) yields a promising approach to enhance patient satisfaction and reduce healthcare costs. While prior data support the safety of SDD after radiofrequency ablation, evidence following pulsed field ablation (PFA) remains limited. This sub-analysis of the admIRE trial (NCT05293639) evaluates the safety of SDD compared with overnight stays (ONS) after PFA using a variable-loop circular catheter (VLCC). METHODS AND RESULTS: Baseline and procedural characteristics, safety, and effectiveness were compared between SDD and ONS groups. Primary effectiveness was defined as freedom from composite failure using Kaplan-Meier estimates. Serious adverse events (SAEs) occurring ≤7 days and ≥1 day post-index procedure were assessed. Amongst 277 patients in the admIRE trial, 119 (43.0%) completed SDD, and 158 (57.0%) stayed overnight. The SDD group included fewer patients aged ≥65 years (41.2% vs. 52.5%), shorter fluoroscopy times (4.0 vs. 8.9 min), higher first-pass isolation rates (97.5% vs. 82.9%), and fewer procedural AEs (1.7% vs. 3.8%). More procedures in the SDD group occurred in the morning (63.0% vs. 39.2%). Freedom from primary effectiveness failure was similar (SDD, 75.4% [95% CI 67.4-83.3%] vs. ONS, 74.0% [95% CI 66.4-81.5%]). No significant difference in SAE risk was observed overall [HR, 1.07 (95% CI 0.47-2.44)] or ≤7 days post-procedure [HR, 0.78 (95% CI 0.17-3.49)]. Post-procedural serious cardiac/vascular AE rates were also comparable (SDD, 2.5% vs. ONS, 1.3%). CONCLUSION: SDD is feasible in a paroxysmal AF population undergoing PFA with the VLCC, demonstrating comparable safety and effectiveness outcomes with overnight hospitalization.