Safety and feasibility of same day discharge catheter ablation: initial German experience

Abstract Background Catheter ablation (CA) is a safe and effective treatment for a range of cardiac arrhythmias and is widely implemented globally. Recent technological advancements have enhanced the safety profile of these procedures, enabling the implementation of same day discharge (SDD) protocols. This approach may help optimize the use of already limited healthcare resources. However, in most European countries, including Germany, inpatient procedures remain the standard of care. Purpose To evaluate the first German experience regarding the safety and efficacy of SDD CA procedures in a tertiary electrophysiology centre. Methods Consecutive patients were prospectively enrolled. Patients undergoing CA for cardiac arrhythmias were discharged on the day of procedure, after the successful ambulation was achieved. Patients <85 years old, without severe comorbidities and living at a reasonable distance from the hospital were considered suitable. All vascular punctures were performed under ultrasound guidance. An outpatient presentation for groin assessment, exclusion of pericardial effusion, and Holter ECG monitoring was scheduled on the next day. Emergency department (ED) visits, unplanned ambulatory presentations, and readmissions were assessed during the first 30 days of follow-up. Results A total of 84 patients (age 59.0 (50.0, 66.0), 28.6% females, BMI 29.0 ± 5.0 Kg/m2) were included between September 2022 and September 2024 (Table 1). Regarding the procedure, 70 (83.3%) patients underwent an AF ablation, 4 (4.8%) of them with additional cavotricuspid isthmus ablation (CTI), another 2 (2.4%) CTI ablation alone, 10 (11.9%) underwent slow pathway ablation for atrioventricular nodal reentry tachycardia and 2 (2.4%) ablation of an accessory pathway. AF ablation procedures were performed using cryoablation in 38 (57.6%) patients, radiofrequency (RF) in 11 (16.7%), pulsed field ablation (PFA) in 16 (24.2%), and laser ablation in 1 (1.5%) patient. One venous puncture was performed in 33.3% of patients, two in 53.6% and 3 in 13.1%. In 36 (42.9%) cases a venous closure system was used for haemostasis. The procedure was successful in all patients. Two (2.4%) patients had minor intraprocedural complications (Table 2). At discharge, 76 (90.5%) patients received medication predisposing to bleeding. The median time between the end of procedure and discharge was 5:03 (4:21; 6:00) hh:mm. Of the 61 (72.6%) patients presenting the day following the procedure, 6 (9.8%) presented minor complications. A total of 4 (4.8%) patients had ED visits during follow-up, 6 (7.1%) patients had unplanned ambulatory visits and 2 (2.4%) unplanned hospitalisations. Conclusions In this single-centre study, same-day discharge after catheter ablation both safe and feasible in selected patients. This approach may enhance healthcare resource utilization and improve patient comfort. Further large-scale studies are required to validate these findings and draw definitive conclusions.Table 1.Baseline characteristics Table 2.Complications