ABSTRACT
Background
Same‐day discharge (SDD) after catheter ablation is increasingly adopted to improve patient convenience and reduce healthcare costs. While SDD following radiofrequency ablation (RFA) is well‐documented, no data exist on SDD in patients undergoing pulsed‐field ablation (PFA) for atrial fibrillation (AF).
Objective
To evaluate the safety of SDD in patients undergoing PFA and RFA for AF, with an exploratory comparison of practice patterns and outcomes.
Methods
From a prospectively maintained registry, we included all consecutive patients undergoing PFA for AF (FARAWAVE catheter) since its FDA approval and patients undergoing AF RFA between March and October 2023 (comparison group). Outcomes included rates of major complications (vascular complications, cerebrovascular accidents, transient ischemic attacks (TIA), phrenic nerve injury, and pericardial effusion requiring intervention), minor complications, readmissions within 30 days, and all‐cause mortality.
Results
The study included 955 PFA patients, of whom 207 (21.7%) were discharged the same day, and 1072 RFA patients, of whom 127 (11.8%) were discharged the same day. Vascular closure modalities differed significantly across groups (p < 0.001). Major complications, including stroke and TIA, occurred in 0.5% of PFA non‐SDD and 1.1% of RFA non‐SDD patients (p = 0.29, p = 0.24), with no major complications in SDD groups and no deaths across all groups. Minor complications were 0.5% for PFA SDD versus 1.1% for PFA non‐SDD (p = 0.44) and 1.6% for both RFA SDD and RFA non‐SDD (p = 0.99), and not significantly different between PFA SDD and RFA SDD (p = 0.31). Readmission rates (UTI, AF, aspiration pneumonia) were similar between SDD patients at 1.4% for PFA and 2.4% for RFA (p = 0.54). A lower CHA2DS2‐VASc score predicted the practice pattern of SDD in the PFA cohort (OR = 0.754, 95% CI: 0.663–0.858, p < 0.001), while being octogenarian reduced the likelihood of SDD (OR = 0.265, 95% CI: 0.105–0.666, p = 0.005).
Conclusion
In this cohort, SDD was found to be a safe and viable option for both PFA and RFA. In this practice, the rates of same‐day discharge were higher in the PFA group versus the RFA group and is being increasingly adopted.
Keywords: atrial fibrillation, complications, procedural safety, pulsed‐field ablation, radiofrequency ablation, same‐day discharge
1. Introduction
Atrial fibrillation is the most common type of sustained cardiac arrhythmia, impacting approximately 33.5 million people worldwide [1]. Described as an epidemic, its prevalence is anticipated to grow significantly in the coming years [2]. Catheter ablation has become a cornerstone in the management of AF, particularly for patients who remain symptomatic despite medical therapy [3].
Traditionally, radiofrequency ablation (RFA) was the primary modality for AF ablation, utilizing thermal energy to create durable lesions. However, pulsed‐field ablation (PFA), a new non‐thermal technique, is increasingly used because of its ability to selectively target tissue while minimizing the risk of damage to nearby structures [5, 6].
Same‐day discharge (SDD) following cardiac invasive procedures is an increasingly adopted strategy aimed at improving patient convenience, reducing hospital costs, and optimizing bed utilization without compromising patient safety [7, 8, 9]. The feasibility and safety of SDD after RFA have been well‐documented. However, there are currently no studies evaluating the safety of SDD in patients undergoing PFA, particularly in the US population.
Given the unique properties of PFA, especially the need for larger sheaths, which may be associated with higher complication rates and its growing adoption, understanding whether SDD after PFA is as safe as after RFA is important for clinical decision‐making and the development of standardized protocols.
In this study, we evaluated the safety of SDD in patients undergoing PFA for AF, comparing outcomes to those of patients undergoing RFA. We also examined practice patterns and identified factors associated with SDD in the PFA cohort to provide insights into the evolving landscape of AF ablation.
2. Methods
2.1. Study Design and Patient Population
All data were collected prospectively in our institutional registry of patients undergoing AF ablation. The study included all consecutive adult patients who underwent catheter ablation for AF between February 2023 and October 2024 at our institution. Patients were divided into two groups based on the ablation modality: those who underwent PFA using the FARAWAVE catheter (Boston Scientific, USA) and those who underwent RFA, both using commercially available catheters.
All ablation procedures, including both PFA and RFA, were performed under general anesthesia. The median number of vascular access punctures was four for RFA (two in the right femoral vein, two in the left femoral vein) and three for PFA (one right femoral vein, two left femoral vein). Double trans‐septal access was typically performed during RFA procedures with both a mapping and ablation catheter introduced to the left atrium, for real‐time assessment of signal during ablation. For PFA, only single trans‐septal access was obtained.
In terms of ablation strategy, pulmonary vein isolation (PVI) was the primary target for both PFA and RFA procedures. Additionally, in our practice, ablation of the posterior wall is routinely performed in almost all patients regardless of ablation modality. This approach is based on the shared embryological origin between the posterior wall and the pulmonary veins and is consistent with a wide antral PVI strategy. Therefore, the extent of ablation beyond PVI was generally similar between the two groups and is unlikely to have influenced SDD decisions.
To evaluate SDD, patients in both groups were further stratified into SDD and non‐SDD cohorts based on their discharge timing. For the most part, patients who undergo ablation earlier in the day without technical or procedural concerns are considered for discharge later in the day. Practical considerations to guide patient selection included hemodynamic stability, absence of acute complications (e.g., pericardial effusion, vascular injury), rapid recovery from anesthesia, and the presence of reliable social support. The same‐day discharge strategy is being increasingly adopted at our institution and preferred whenever felt to be safe on a case‐by‐case basis. As a referral center, we perform ablations on a significant number of patients who travel from a distance to receive our care, and we typically ask such patients to spend the night locally for easy access to our healthcare facilities in case of a complication.
2.2. Outcome Measures
Baseline characteristics, including demographic data, medical history, and echocardiographic parameters, were extracted from the institutional registry. Procedural details such as the type of ablation modality and vascular closure techniques employed were documented. At our institution, the two main vascular closure devices utilized are the Perclose ProGlide (Abbott Vascular, USA), a suture‐mediated closure system, and the Vascade (Cardiva Medical, USA), a collagen‐based device. For large‐bore sheaths used in PFA, we have primarily used the Perclose system or figure‐of‐eight sutures, while collagen‐based closure systems like Vascade or figure‐of‐eight sutures were used to close smaller access sites. Bed rest after ablation was primarily 4–6 h post RFA, but we have transitioned in our practice to shorter bed rest times, and inherently our post PFA bed rest times have ranged between 2 and 4 h.
Outcomes of interest encompassed major complications, including vascular complications, cerebrovascular events (stroke and TIA), phrenic nerve injury, and pericardial effusion requiring intervention, as well as minor complications, defined as clinically insignificant events requiring no major intervention. Additionally, hospital readmissions within 30 days of the index procedure and all‐cause mortality during the study period were assessed. Patients presented for follow‐up appointments 3–4 months after ablation, and all interval events were collected.
All complications were prospectively entered into a complication database and further adjudicated during monthly morbidity and mortality conferences.
The primary outcome was the safety of SDD, determined by the rates of major and minor complications, readmissions, and all‐cause mortality in both the PFA and RFA groups. Secondary outcomes involved identifying predictors of SDD within the PFA cohort.
2.3. Statistical Analysis
Categorical variables were reported as frequencies and percentages, while continuous variables were presented as mean ± standard deviation. Differences between groups (SDD vs. non‐SDD and PFA vs. RFA) were assessed using Chi‐square or Fisher's exact test for categorical variables and Student's t‐test or Mann‐Whitney U test for continuous variables, depending on normality.
Logistic regression analysis was performed to identify predictors of SDD within the PFA group. Variables with a p value <0.10 on univariate analysis were included in the multivariable model. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were reported. Statistical significance was set at a two‐sided p value <0.05.
2.4. Ethical Considerations
The study protocol was reviewed and approved by the institutional review board. Measures were taken to adhere to standards of data safety and protection.
3. Results
3.1. Study Population
Between February 27, 2023 and October 9, 2024, a total of 2027 patients underwent catheter ablation for AF. 955 underwent PFA between February 26, 2024 and October 9, 2024, and 1072 underwent RFA between February 27, 2023 and October 9, 2023. Among the PFA cohort, 207 (21.7%) were discharged the same day (SDD), while 748 (78.3%) were not. In the RFA cohort, 127 (11.8%) were SDD, and 945 (88.2%) were not (Figure 1).
FIGURE 1.
Flowchart of study inclusion. AF, atrial fibrillation; PFA, pulsed‐field ablation; RFA, radiofrequency ablation; SDD, same day discharge.
Baseline characteristics revealed that SDD patients were generally younger and had significantly lower CHA2DS2‐VASc scores compared to non‐SDD patients in both the PFA and RFA cohorts. In the PFA group, the mean age was 65.2 ± 10.8 years in the SDD group versus 68.4 ± 10.0 years in the non‐SDD group (p < 0.001), and in the RFA group, it was 63.3 ± 9.5 versus 67.1 ± 9.6 years, respectively (p < 0.001). CHA2DS2‐VASc scores were also lower in SDD patients, with 35.7% having a score of 0–1 in the PFA group compared to 27.9% in non‐SDD (p = 0.009), and 50.4% versus 32.1% in the RFA group (p = 0.008). Octogenarians were significantly less likely to be discharged the same day in both groups (PFA: 2.4% vs. 8.6%, p = 0.003; RFA: 0.8% vs. 6.8%, p = 0.008). Fewer females were discharged the same day (PFA: 25.1% vs. 34.1%, p = 0.014; RFA: 23.7% vs. 33.1%, p = 0.031). Redo procedures were significantly less common in PFA SDD patients (16.9% vs. 23.7%, p = 0.038), but more common in RFA SDD patients, although not significantly (30.7% vs. 25.9%, p = 0.251). Fewer PFA SDD patients had valvular heart disease (11.6% vs. 17.2%, p = 0.05), and while fewer SDD patients were on anti‐arrhythmic drugs in both groups, significance was reached only in RFA (26.8% vs. 15.4%, p = 0.003). NYHA functional class distribution differed significantly in both cohorts (PFA p < 0.001; RFA p = 0.003), with a higher proportion of SDD patients in lower classes. Other comorbidities—including CAD, MI, diabetes, hypertension, PAD, OSA, congenital heart disease, and cardiomyopathy—were similar between groups (Table 1).
TABLE 1.
Baseline characteristics of patients undergoing pulsed‐field ablation (PFA) or radiofrequency ablation (RFA), stratified by same‐day discharge (SDD) status.
| PFA SDD (n = 207) | PFA non‐SDD (n = 748) | p value (PFA) | RFA SDD (n = 127) | RFA non‐SDD (n = 945) | p value (RFA) | p value (PFA SDD vs. RFA SDD) | |
|---|---|---|---|---|---|---|---|
| Age | 65.19 (±10.84) | 68.44 (±9.99) | p < 0.001 | 63.33 (±9.5) | 67.11 (±9.60) | p < 0.001 | 0.026 |
| BMI | 29.86 (±5.97) | 29.65 (±5.93) | 0.850 | 31.43 (±7.48) | 30.91 (±6.32) | 0.671 | 0.081 |
| EF | 55.38 (±9.24) | 54.94 (±26.11) | 0.217 | 56.9 (±8.99) | 54.95 (±10.55) | 0.167 | 0.163 |
| DOAC | 199 (96.1) | 708 (94.7) | 0.387 | 119 (93.7) | 851 (90.05) | 0.392 | 0.312 |
| Prior PVI here | 24 (11.6) | 106 (14.2) | 0.081 | 29 (22.8) | 147 (15.6) | 0.098 | 0.011 |
| AAD | 54 (26.1) | 138 (18.4) | 34 (26.8) | 146 (15.44) | 0.003 | 0.890 | |
| NYHA | p < 0.001 | 0.003 | 0.048 | ||||
|
32 (15.5) | 95 (12.7) | 32 (25.2) | 275 (29.1) | |||
|
38 (18.4) | 268 (35.8) | 29 (22.8) | 307 (32.5) | |||
|
4 (1.9) | 29 (3.9) | 0 (0) | 20 (2.1) | |||
|
1 (0.5) | 1 (0.1) | 0 (0) | 0 (0) | |||
| CAD | 6 (2.9) | 15 (2) | 0.646 | 1 (0.8) | 7 (0.7) | 0.954 | 0.191 |
| History of MI | 9 (4.3) | 33 (4.4) | 0.348 | 3 (2.4) | 50 (5.3) | 0.32 | 0.570 |
| Diabetes | 23 (11.1) | 110 (14.7) | 0.360 | 12 (8.5) | 130 (13.8) | 0.179 | 0.630 |
| Hypertension | 120 (58.0) | 430 (57.5) | 0.866 | 64 (50.40 | 487 (51.5) | 0.809 | 0.177 |
| PAD | 4 (1.9) | 32 (4.3) | 0.207 | 3 (2.4) | 36 (3.8) | 0.220 | 0.952 |
| CHADSVASC score | 0.009 | 0.008 | 0.195 | ||||
| 0–1 | 74 (35.74) | 209 (27.94) | 64 (50.39) | 303 (32.06) | |||
| 2–4 | 68 (32.85) | 444 (59.35) | 60 (47.24) | 571 (60.42) | |||
| ≥5 | 7 (3.38) | 95 (12.7) | 3 (2.36) | 71 (7.51) | |||
| OSA | 40 (19.3) | 156 (20.9) | 0.871 | 32 (25.2) | 197 (20.8) | 0.206 | 0.448 |
| Congenital heart disease | 2 (1) | 10 (1.3) | 0.601 | 2 (1.6) | 21 (2.2) | 0.835 | 0.620 |
| Valvular HD | 24 (11.6) | 129 (17.2) | 0.05 | 11 (8.7) | 138 (14.6) | 0.178 | 0.396 |
| Cardiomyopathy | 47 (22.7) | 187 (25) | 0.497 | 22 (17.3) | 218 (23.1) | 0.274 | 0.238 |
| Gender (female) | 52 (25.1) | 255 (34.1) | 0.014 | 30 (23.7) | 313 (33.1) | 0.031 | 0.757 |
| Redo ablation | 35 (16.9) | 177 (23.7) | 0.038 | 39 (30.7) | 245 (25.9) | 0.251 | 0.003 |
| Persistent AF | 115 (55.6) | 470 (62.8) | 0.161 | 67 (52.8) | 577 (61.1) | 0.198 | 0.862 |
| Octogenarian (age ≥ 80) | 5 (2.4) | 64 (8.6) | 0.003 | 1 (0.8) | 64 (6.8) | 0.008 | 0.277 |
Note: Continuous variables are presented as mean ± standard deviation. Categorical variables are presented as frequency n (%).
Abbreviations: AAD, antiarrhythmic drug; AF, atrial fibrillation; BMI, body mass index; CAD, coronary artery disease; CABG, coronary artery bypass grafting; CHADSVASC, congestive heart failure, hypertension, age ≥75, diabetes, stroke/TIA/thromboembolism, vascular disease, age 65–74, and sex category score; CKD, chronic kidney disease; COPD, chronic obstructive pulmonary disease; CVD, cerebrovascular disease; DM, diabetes mellitus; DOAC, direct oral anticoagulant; EF, ejection fraction; HCM, hypertrophic cardiomyopathy; ICD, implantable cardioverter‐defibrillator; MI, myocardial infarction; NICM, non‐ischemic cardiomyopathy; NYHA, New York Heart Association; OSA, obstructive sleep apnea; PAD, peripheral arterial disease; PVI, pulmonary vein isolation; SDD, same‐day discharge.
3.2. Procedural Details
Vascular closure modalities differed significantly across groups (p < 0.001). Collagen‐based closure devices were the most commonly used in both SDD groups, accounting for 63.8% in PFA SDD and 94.5% in RFA SDD. In contrast, their use was lower in the non‐SDD groups (52.0% in PFA non‐SDD and 63.8% in RFA non‐SDD). Suture‐based closure devices were the second most frequently employed, used in 30.0% of PFA SDD and 2.4% of RFA SDD, while their use was 25.1% in PFA non‐SDD and 17.2% in RFA non‐SDD. External sutures were used in 5.8% of PFA SDD and 3.1% of RFA SDD, compared to 20.2% in PFA non‐SDD and 18.7% in RFA non‐SDD. Manual compression was rarely used, with no cases in PFA SDD, 0.4% in PFA non‐SDD, no cases in RFA SDD, and 0.2% in RFA non‐SDD (Table 2).
TABLE 2.
Vascular closure modality among patients undergoing pulsed‐field ablation (PFA) or radiofrequency ablation (RFA), stratified by same‐day discharge (SDD) status.
| PFA SDD (n = 207) | PFA non‐SDD (n = 748) | p value (PFA) | RFA SDD (n = 127) | RFA non‐SDD (n = 945) | p value (RFA) | p value (PFA SDD vs. RFA SDD) | |
|---|---|---|---|---|---|---|---|
| Vascular closure modality | p < 0.001 | p < 0.001 | p < 0.001 | ||||
| Manual compression | 0 (0) | 3 (0.4) | 0 (0) | 2 (0.2) | |||
| External suture | 12 (5.8) | 151 (20.2) | 4 (3.1) | 168 (18.7) | |||
| Suture‐based device | 62 (30) | 188 (25.1) | 3 (2.4) | 155 (17.2) | |||
| Collagen‐based device | 132 (63.8) | 389 (52.0) | 120 (94.5) | 574 (63.8) |
Note: Continuous variables are presented as mean ± standard deviation. Categorical variables are presented as frequency n (%).
3.3. Safety Outcomes
Major complications were infrequent in the entire cohort. In the PFA non‐SDD group, all major complications were vascular complications, with a rate of 0.5%, compared to 1.1% in the RFA non‐SDD group (p = 0.29). In the RFA non‐SDD group, major complications included four vascular complications (0.42%), two cerebrovascular accidents/transient ischemic attacks (0.21%), three phrenic nerve injuries (0.32%), and one pericardial effusion requiring intervention (0.20%). No major complications occurred in either SDD group.
Minor complication rates were low across all groups, with no significant differences. In the PFA cohort, the rate was 0.5% for SDD versus 1.1% for non‐SDD (p = 0.44). In the RFA cohort, minor complications were 1.6% for both SDD and non‐SDD patients (p = 0.99). There was no significant difference in minor complication rates between PFA SDD and RFA SDD patients (p = 0.31).
Readmission rates were similar among SDD patients, occurring in 1.4% of the PFA SDD group and 2.4% of the RFA SDD group (p = 0.54). The primary reasons for readmission included urinary tract infections, recurrent AF, and aspiration pneumonia. Readmission rates were not significantly different between SDD and non‐SDD groups within each cohort.
No deaths occurred in either SDD or non‐SDD groups during the study period (Table 3).
TABLE 3.
Procedural outcomes, complications, readmissions, and mortality following pulsed‐field ablation (PFA) or radiofrequency ablation (RFA), stratified by same‐day discharge (SDD) status.
| PFA SDD | PFA non‐SDD | p value (PFA) | RFA SDD | RFA non‐SDD | p value (RFA) | p value (PFA SDD vs. RFA SDD) | |
|---|---|---|---|---|---|---|---|
| Major complications: | 0 (0) | 8 (0.5) | 0.292 | 0 (0) | 10 (1.1) | 0.244 | |
| Vascular | 0 (0) | 8 (0.5) | 0 (0) | 4 (0.42) | |||
| CVA/TIA | 0 (0) | 0 (0) | 0 (0) | 2 (0.21) | |||
| Phrenic nerve injury | 0 (0) | 0 (0) | 0 (0) | 3 (0.32) | |||
| Pericardial effusion requiring intervention | 0 (0) | 0 (0) | 0 (0) | 1 (0.20) | |||
| Minor complications | 1 (0.5) | 8 (1.1) | 0.440 | 2 (1.6) | 15 (1.6) | 0.992 | 0.305 |
| Readmission rates | 3 (1.4) | 10 (1.3) | 0.902 | 3 (2.4) | 29 (3.1) | 0.660 | 0.542 |
| All‐cause mortality | 0 (0) |
0 (0) |
0 (0) |
0 (0) |
Note: Categorical variables are presented as frequency n (%). No continuous variables included.
Abbreviations: CVA, cerebrovascular accident; TIA, transient ischemic attack; PFA, pulsed‐field ablation; RFA, radiofrequency ablation; SDD, same‐day discharge.
3.4. Predictors of Same‐Day Discharge in PFA
Logistic regression analysis identified lower CHA2DS2‐VASc scores as a significant predictor of SDD in the PFA cohort (OR = 0.754, 95% CI: 0.663–0.858, p < 0.001). Similarly, shorter procedure duration was also significantly associated with higher likelihood of SDD (OR = 0.993 per minute increase, 95% CI: 0.989–0.996, p < 0.001). Conversely, being octogenarian significantly reduced the likelihood of SDD (OR = 0.265, 95% CI: 0.105–0.666, p = 0.005). Coronary artery disease (CAD) approached significance as a predictor (OR = 0.328, 95% CI: 0.103–1.044, p = 0.059) (Table 4).
TABLE 4.
Predictors of same‐day discharge (SDD) following pulsed‐field ablation (PFA).
| 95% CI | ||||
|---|---|---|---|---|
| OR | Lower | Upper | p value | |
| CHADSVASC | 0.754 | 0.663 | 0.858 | p < 0.001 |
| CAD | 0.328 | 0.103 | 1.044 | 0.059 |
| Octogenarian (age ≥ 80) | 0.265 | 0.105 | 0.666 | 0.005 |
| Procedure duration | 0.993 | 0.989 | 0.996 | p < 0.001 |
Note: Odds ratios (OR) with 95% confidence intervals (CI) and associated p values are shown.
Abbreviations: CHADSVASC, congestive heart failure, hypertension, age ≥75, diabetes mellitus, stroke, vascular disease, age 65–74, sex category score; CAD, coronary artery disease; OR, odds ratio; CI, confidence interval; PFA, pulsed‐field ablation; SDD, same‐day discharge.
4. Discussion
This study evaluated the relationship between PFA, RFA, and SDD, with particular attention to vascular closure modalities. We found that PFA patients were discharged on the same day at nearly twice the rate of RFA patients, with the use of collagen‐based vascular closure devices being significantly more prevalent in the PFA‐SDD group. Additionally, older age was a significant barrier to SDD, consistent with broader trends in procedural recovery.
Our results reveal two major insights. First, PFA appears to facilitate SDD more readily than RFA—mostly due to operators’ lower concern with adverse events. Unlike RFA, which relies on thermal energy and can result in collateral tissue damage, PFA uses non‐thermal electroporation, reducing the risk of pericardial complications [5, 6]. This may contribute to a more favorable post‐procedural recovery trajectory, allowing for earlier discharge, even if the incidence of major complications is similar.
Second, vascular closure strategy plays a critical role in achieving SDD. Collagen‐based closure devices were used more frequently in the PFA group, particularly among those discharged the same day. This aligns with previous studies demonstrating the utility of these devices in reducing hemostasis time and promoting early mobilization [10]. However, existing research on closure devices has not explicitly differentiated outcomes by ablation modality, making this study one of the first to explore this relationship in the context of PFA.
Our findings suggest that older patients, despite undergoing PFA, were less likely to be discharged the same day. This reduced SDD rate in octogenarians was not driven by observed complications in our cohort, but likely reflects a more cautious clinical approach in such patients [11]. Our results indicate that such patients may still benefit from SDD due to favorable safety profiles.
4.1. Clinical Implications
The implications of the current study apply primarily to SDD and vascular closures in PFA. We suggest that institutions adopting PFA should consider incorporating SDD protocols, especially for younger, lower‐risk patients. The safety profile of PFA would allow further expansion of SDD practice without compromising outcomes. Furthermore, vascular closure strategies enhance SDD practices, but it remains unknown if other hemostasis strategies, such as manual compression, would be sufficient when SDD is considered. This deserves further investigation.
Beyond individual patient care, widespread adoption of PFA and SDD protocols could significantly impact procedural workflow. By reducing overnight hospital stays, SDD has the potential to optimize bed availability, increase patient turnover, and reduce the burden on inpatient resources [12]. This could be especially beneficial for high‐volume centers, where bed occupancy often acts as a bottleneck for procedural scheduling.
From an economic perspective, facilitating SDD may result in cost savings by minimizing hospital stay expenses. A recent study by Arujuna et al. highlighted significant cost savings achieved by conducting SDD after cryoballoon ablations [13]. Nonetheless, it is essential to recognize that SDD should be approached on a case‐by‐case basis, accounting for co‐morbidities, technical challenges during the procedures, as well as the duration of general anesthesia.
4.2. Limitations and Future Directions
This study has the limitations inherent to its observational nature. Even though the data were prospectively collected, there was no standardized protocol to guide SDD decisions. However, the data reflect operators’ preference in real‐life practice and suggest that SDD practices are increasingly adopted. Another limitation is that the current cohort reports on practices from a large volume tertiary care center and may not necessarily apply to lower volume centers. That being said, the favorable safety profiles with PFA would suggest that wider adoption is reasonable.
5. Conclusion
SDD is a safe and feasible option for patients undergoing PFA for atrial fibrillation, with higher SDD rates compared to RFA in our practice. Younger age, lower CHA2DS2‐VASc scores, and collagen‐based vascular closure were key factors facilitating SDD.
Author Contributions
Adele Watfa, Joe Demian, Chadi Tabaja, Bryan Baranowski, Koji Higuchi, Mina K. Chung, Jakub Sroubek, Shady Nakhla, Mohamed Kanj, Justin Z. Lee, Mandeep Bhargava, and Mohamad Mdaihly have nothing to disclose. Pasquale Santangeli is a consultant and/or speaker with Boston Scientific Corporation, Biotronik, Inc., Medical Device Business Services, Inc., formerly Depuy, Inc., and Abbott Laboratories. Oussama M. Wazni is a consultant and/or speaker with Boston Scientific Corporation, and Biosense Webster, Inc. Tyler Louis Taigen, Walid I. Saliba, Ayman A. Hussein, and Arwa Younis are consultants and/or speakers with Boston Scientific Corporation. Thomas D. Callahan is a consultant and/or speaker with Boston Scientific Corporation, Philips, or Medtronic plc. Hiroshi Nakagawa is a consultant and/or speaker Biosense Webster, Inc., Japan Lifeline Co., Ltd., Toyohashi Heart Center, Volta Medical, Inc., Fukuda Denshi Co., Ltd.
Conflicts of Interest
The authors declare no conflicts of interest.
Funding: The authors received no specific funding for this work.
Data Availability Statement
The data used in this analysis can be shared upon reasonable request.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data used in this analysis can be shared upon reasonable request.