Same day discharge can be performed safely after atrial fibrillation catheter ablation using a wide-footprint lattice-tip dual-energy system

Background Same-day discharge (SDD) after atrial fibrillation (AF) ablation is generally considered safe, since most complications are identified during (or immediately) after the procedure. Objective This study aimed to evaluate SDD in the SPHERE Persistent-Atrial Fibrillation trial. Methods Patients with persistent AF were randomized to the dual-energy lattice-tip mapping and ablation catheter (investigational) vs a conventional contact-force radiofrequency ablation system (control). SDD and timing of 30-day procedure- or device-related serious adverse events (SAEs) were assessed in the full cohort. In a subset of centers that performed SDD in the trial, predictors of SDD, 30-day readmissions, and mortality rates were assessed. Results SDD was achieved in 229 of 418 (54.8%) patients (55.9% of investigational [n = 211] and 53.6% of control [n = 207; P = .64]). Of the remaining patients, 181 (43.3%) were discharged the next day, whereas 8 (1.9%) were discharged 2–7 days post-ablation. A total of 11 of 14 procedure- or device-related SAEs occurred within the first 3 days post-procedure, with no relevant difference between SDD and overnight stay. In a subset of 14 centers with at least one SDD in the trial, procedure duration, procedure end time, and race predicted overnight stay (all P < .01). All-cause 30-day readmission rates were similar between arms ( P = .53) and discharge protocols ( P = .19), with no deaths within 30 days. Conclusion Among the traditional thermal ablation technologies, SDD protocols have been well-established and safely practiced. Here, SDD was safely achieved, with no significant differences in outcome when performed with the investigational system compared with a conventional contact-force radiofrequency ablation system.