Abstract
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.