Qi-452785-1 same-day discharge after catheter ablation of atrial fibrillation in a multicenter registry (real-af)

Same-day discharge (SDD) after catheter ablation of atrial fibrillation (AF) has become increasingly common, improving healthcare resource utilization, reducing procedure-related costs, and possibly increasing patient satisfaction. Nevertheless, most data regarding the safety of SDD originate from cohorts, including patients from a limited number of centers. To determine the safety and efficacy of our previously described protocol for SDD in a prospective analysis and identify patients’ characteristics that render them ineligible to implement this strategy. The REAL-AF registry is a multi-center registry. Based on the protocol eligibility criteria (CHA2DS2-VASc score ≤3, stable anticoagulation, absence of bleeding history, no interventional procedures within 60 days of ablation, and BMI < 35 kg/m2), operators prospectively determined whether or not patients undergoing ablation for paroxysmal or persistent AF were candidates for SDD (SDD and the non-SDD groups). After the procedure, SDD occurred if the patient fulfilled the protocol discharge criteria (stable hemodynamics, no evidence of complications, ability to ambulate). The primary efficacy endpoint was to describe procedural outcomes predicted by the protocol, including the occurrence of procedure-related complications in the non-SDD group. The secondary endpoint was to determine the percentage of patients successfully discharged as planned (successful SDD [S-SDD] vs. unsuccessful SDD [U-SDD]). A total of 2328 patients were included, out of which 1977 (84.9%) fulfilled the eligibility criteria for SDD (SDD group), and 351 (15.1%) compounded the non-SDD group. S-SDD occurred in 85.9% (1699/1977) of patients. The U-SDD group underwent longer ablation (23.2±13.9 vs. 21.1±10.8; p= 0.005) and procedure time (98±55 vs. 92±43; p= 0.038). Likewise, the non-SDD group underwent more procedural (113±54 vs. 93±45; p< 0.001) and ablation time (24.5±12.2 vs. 21.4±11.3; p< 0.001). In the non-SDD, as determined by our protocol, the rate of acute complications was higher [4.6% (16/351 vs. 1.7% (35/1977 vs); p< 0.001]. The reported complications were mainly pericarditis and vascular access complications. In a large multicenter registry, using a standardized protocol not only identified a high proportion of patients suitable for SDD but also predicted procedural outcomes and patients with a high risk of complications. Interestingly, patients selected by the protocol for SDD presented a low rate of procedural complications.