Suture-Mediated Vascular Closure Improves Same-Day Discharge in Atrial Fibrillation Ablation and Left Atrial Appendage Occlusion

Q: What are the key findings of this study?

Suture-mediated vascular closure increased same-day discharge rates from 67.0% to 97.5% and reduced time to discharge by 64.6% compared with Figure-of-8 closure.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Atrial fibrillation ablation (pulsed field ablation) and left atrial appendage occlusion (n=139). Intervention: Standardized suture-mediated vascular closure protocol (Perclose ProGlide) vs. Figure-of-8 suture closure approach. Primary outcome: Same-day discharge (SDD) rate (p=<0.001).

Q: What does this research mean for the field?

Suture-mediated vascular closure significantly increases same-day discharge rates and reduces time to discharge and ambulation compared with Figure-of-8 closure after electrophysiology and left atrial appendage occlusion procedures. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To determine whether a standardized suture-mediated vascular closure protocol reduces recovery duration and improves same-day discharge rates after large-bore femoral venous access procedures.

Mark J. Shen; Shal T. Shen; Hannah Serrano

doi:10.1016/j.jaccas.2026.109427

September 1, 2026JACC Case ReportsOpen Access

Suture-Mediated Vascular Closure Improves Same-Day Discharge in Atrial Fibrillation Ablation and Left Atrial Appendage Occlusion

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Key result

Suture-mediated closure is linked to ~31-point higher same-day discharge rates versus Figure-of-8 closure.

P<0.001
n=139

Graphical abstract published by JACC Case Reports — Graphical abstract · Published by JACC Case Reports · CC BY 4.0

Why the study?

Prolonged bed rest after large-bore femoral venous access limits reliable same-day discharge after atrial fibrillation ablation and left atrial appendage occlusion procedures.

Does a standardized suture-mediated vascular closure protocol improve same-day discharge rates and shorten time to ambulation and discharge compared with Figure-of-8 closure in patients undergoing atrial fibrillation ablation and left atrial appendage occlusion?

Key Points

To determine whether a standardized suture-mediated vascular closure protocol reduces recovery duration and improves same-day discharge rates after large-bore femoral venous access procedures.
Retrospective comparison of 139 consecutive patients undergoing selected atrial fibrillation ablation or left atrial appendage occlusion requiring large-bore femoral venous access (12- to 16-F).
Evaluated sequential workflow periods comparing a preimplementation Figure-of-8 closure approach against a postimplementation suture-mediated closure pathway using Perclose ProGlide.
Suture-mediated closure reduced time to ambulation from 6.1 ± 1.3 hours to 3.2 ± 1.1 hours (47.5% reduction, P < 0.001) and time to discharge from 11.6 ± 7.1 hours to 4.1 ± 2.8 hours (64.6% reduction, P < 0.001).
Same-day discharge increased from 67.0% with Figure-of-8 closure to 97.5% with suture-mediated closure (P < 0.001), without an observed increase in vascular or bleeding complications.

Study Design

Type

Cohort (n=139)

Multicenter

No

Structured PICO

Does a standardized suture-mediated vascular closure protocol improve same-day discharge rates and shorten time to ambulation and discharge compared with Figure-of-8 closure in patients undergoing atrial fibrillation ablation and left atrial appendage occlusion?

P

Population

139 consecutive patients undergoing selected pulsed field atrial fibrillation ablation and left atrial appendage occlusion procedures requiring 12- to 16-F large-bore femoral venous access at a single center.

E

Exposure

Standardized suture-mediated vascular closure (SMC) pathway using Perclose ProGlide (n=81) implemented by a multidisciplinary team to achieve rapid hemostasis and reduce mandatory bedrest duration.

C

Comparator

Traditional Figure-of-8 suture closure and manual compression workflow during the preimplementation period (n=58).

O

Outcome

Primary workflow outcomes: time to ambulation, time to discharge, and same-day discharge (SDD) rate measured via electronic health record timestamps.

Main Result

Absolute Event Rate: 97.5% vs 67%

p-value: p=<0.001

Implementing a standardized suture-mediated vascular closure pathway after large-bore venous access for AF ablation and LAAO significantly accelerates ambulation and hospital discharge, enabling a highly predictable 97.5% same-day discharge rate without increasing bleeding or vascular complications.

Limitations

Retrospective, non-randomized, single-operator, single-center comparison during initial implementation
Other operators were excluded because they maintained existing closure practices
Findings may reflect operator-specific workflow, technique, patient selection, and temporal changes
Modest sample size may not fully capture rare complications
Patient-reported outcomes, staff workload measures, and formal cost analyses were not included
Retrospective, single-operator, single-center comparison during initial implementation
Non-randomized sequential workflow comparison subject to operator-specific workflow, patient-selection factors, and temporal changes
Modest sample size that may not fully capture rare complications
Lack of patient-reported outcomes, staff workload measures, and formal cost analyses

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Implication

May facilitate same-day discharge after AF ablation; hypothesis-generating and requires randomized confirmation before practice change.

Abstract

BACKGROUND: Same-day discharge after atrial fibrillation ablation and left atrial appendage occlusion procedures may improve patient experience, bed availability, and procedural throughput, but prolonged bed rest remains a common operational barrier. PROJECT RATIONALE: We identified the vascular closure strategy and recovery time as modifiable constraints limiting reliable same-day discharge after large-bore femoral venous access. PROJECT SUMMARY: A multidisciplinary team implemented a standardized suture-mediated vascular closure protocol for selected atrial fibrillation ablation and left atrial appendage occlusion procedures. In a retrospective comparison of 139 consecutive cases, suture-mediated closure was associated with shorter time to ambulation, shorter time to discharge, and a higher same-day discharge rate compared with Figure-of-8 closure, without an observed increase in vascular or bleeding complications. TAKE-HOME MESSAGES: Standardized suture-mediated closure may help convert same-day discharge into a predictable operational pathway. Procedural efficiency and patient safety should be measured together.

Discussion

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Cite This Study

Shen et al. (2026) conducted a cohort in Atrial fibrillation ablation (pulsed field ablation) and left atrial appendage occlusion (n=139). Standardized suture-mediated vascular closure protocol (Perclose ProGlide) vs. Figure-of-8 suture closure approach was evaluated on Same-day discharge (SDD) rate (p=<0.001). Suture-mediated vascular closure increased same-day discharge rates from 67.0% to 97.5% and reduced time to discharge by 64.6% compared with Figure-of-8 closure.

synapsesocial.com/papers/6aae47640c69660b71ecc656 https://doi.org/10.1016/j.jaccas.2026.109427

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Suture-Mediated Vascular Closure Improves Same-Day Discharge in Atrial Fibrillation Ablation and Left Atrial Appendage Occlusion

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Suture-Mediated Vascular Closure Improves Same-Day Discharge in Atrial Fibrillation Ablation and Left Atrial Appendage Occlusion

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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