Same-day discharge versus overnight stay after catheter ablation for atrial fibrillation: a systematic review and meta-analysis

Abstract Background The safety of same day discharge after atrial fibrillation ablation remains uncertain because prior evidence relied mainly on heterogeneous observational studies with limited control of confounding. This systematic review and meta-analysis compared structured same day discharge with overnight stay. Methods We searched MEDLINE, Embase, Web of Science, Scopus, CENTRAL, Epistemonikos and LILACS from 1994 to May 2025 for randomized and nonrandomized controlled studies of adults undergoing atrial fibrillation ablation with pulmonary vein isolation. Comparisons were protocolized same day discharge versus overnight hospitalization. Outcomes were all-cause mortality, short term (30-day) unplanned medical contact (readmissions or emergency visits), and procedural complications. Random-effects models generated pooled odds ratios (ORs) with 95% confidence intervals. Results Nineteen studies (26,335 patients) met inclusion criteria, including two randomized trials and seventeen non-randomized studies. Same day discharge success averaged 89% across structured programs. Mortality was rare in both groups, and pooled mortality did not differ between strategies. At 30 days, same day discharge was not associated with excess of readmission or emergency department visits and the pooled estimate favored same day discharge (OR 0.63; 95% CI 0.51–0.78; I 2 0%). Complication rates were low in both groups, although definitions varied. Most non-randomized studies had moderate to serious risk of bias. Conclusion Structured same day discharge after atrial fibrillation ablation shows no evidence of increased mortality, major complications, or unplanned healthcare use in selected outpatients. Implementation should rely on explicit eligibility criteria and early follow up. Further randomized trials are required to establish safety in higher-risk populations and to evaluate the safety of newer ablation technologies.