Patient and Procedural Factors Associated With Same‐Day Discharge Following Pulsed Field Ablation for Atrial Fibrillation: Insights From the DISRUPT‐AF Registry

ABSTRACT

Background

Same‐day discharge (SDD) after catheter ablation for atrial fibrillation (AF) may improve patient satisfaction and optimize healthcare resources. Pulsed field ablation (PFA) offers a favorable safety profile, potentially enabling broader adoption of SDD strategies.

Objective

To evaluate site‐level practice patterns and participant‐ and procedure‐related factors associated with SDD after de novo PFA for AF.

Methods

We analyzed data from participants in the DISRUPT‐AF registry, a prospective, multicenter study evaluating ablation acute outcomes with a pentaspline PFA catheter. We examined participant and procedure characteristics associated with both SDD planning and success.

Results

SDD was preplanned for 81% (1203) of all cases; 93% (1118) of those preplanned were successful. Acute procedural complication rates were low across discharge strategies (0.7% SDD planned vs. 0.7% not planned, p = 0.956). SDD planning was associated with shorter procedure time (60.6 vs. 66.8 min, p < 0.001), fewer procedures starting after 2 p.m. (p < 0.001), and fewer adjunctive ablations beyond pulmonary vein isolation (PVI) (p < 0.001). Unsuccessful SDD was associated with prior stroke/transient ischemic attack (TIA) (16.0% vs. 5.9%, p < 0.001), higher CHA₂DS₂‐VASc score (p = 0.001), lower left ventricular ejection fraction (p = 0.031), later procedure start (p < 0.001), and higher acute complication rates (7.1% vs. 0.3%, p < 0.001).

Conclusion

In this large multicenter registry, SDD after PFA was widely adopted, safe, and successful in most planned cases. Unsuccessful SDD was strongly associated with acute complications and comorbid conditions, underscoring the need for careful candidate selection to optimize safety and efficiency.

Clinical Trial Registration

Trial Registration: NCT06335082.

Abbreviations

AF

atrial fibrillation

AKI

acute kidney injury

BMI

body mass index

CA

catheter ablation

CBA

cryoballoon ablation

CI

confidence interval

DISRUPT‐AF

the registry‐based collaborative to measure efficiency, effectiveness, and safety of Farapulse pulsed field ablation technology for atrial fibrillation

EDC

electronic data capture

GLMM

generalized linear mixed model

HFrEF

heart failure with reduced ejection fraction

HRCRS

Heart Rhythm & Clinical Research Solutions

LVEF

left ventricular ejection fraction

MI

myocardial infarction

NCDR

National Cardiovascular Data Registry

PFA

pulsed field ablation

PV

pulmonary vein (s)

PVI

pulmonary vein isolation

RFA

radiofrequency ablation

SD

standard deviation

SDD

same‐day discharge

TIA

transient ischemic attack

WCG

WIRB‐Copernicus Group

WIRB

Western Institutional Review Board

1. Introduction

The prevalence of atrial fibrillation (AF) in the United States is estimated to reach between 14 and 17 million cases by 2030 with increasing risks to a larger aging population [1, 2]. AF poses a substantial resource burden to patients and healthcare systems [3, 4, 5, 6, 7, 8, 9]. Considering the increasing demand, healthcare systems need to focus on evidence‐ and value‐based care and resource optimization. Catheter ablation (CA) is a first‐line recommendation to treat AF, and same‐day discharge (SDD) following AF ablation is one potential strategy to reduce hospital length of stay, improve the patient experience, and lower costs without compromising safety [10]. Recent studies suggest that SDD from hospitals and Ambulatory Surgical Centers (ASCs) is a safe and increasing possibility following pulsed field ablation (PFA) [11, 12, 13].

PFA is a nonthermal [14] energy modality that does not primarily use temperature extremes to complete ablation and has promising safety and efficacy results from pivotal clinical trials [15, 16, 17]. There may be factors with PFA that are more suitable for SDD, including potentially easier recovery and lower risk of emergency room admissions [18], yet limited data exist on real‐world PFA‐SDD outcomes. The objective of this study was to analyze institutional practices, patient, and procedural characteristics associated with SDD success in the registry‐based collaborative to measure efficiency, effectiveness, and safety of Farapulse pulsed field ablation technology for atrial fibrillation (DISRUPT‐AF) registry.

2. Materials and Methods

This registry‐based collaborative to measure efficiency, effectiveness, and safety of Farapulse PFA technology for the de novo treatment of AF (DISRUPT‐AF: NCT 06335082) is a prospective, observational, multicenter, real‐world evidence registry enrolling up to 10 000 participants at 25 different sites across the United States. The registry was designed to assess both acute and long‐term procedural and clinical safety and efficacy outcomes of AF ablation using a pentaspline PFA catheter (FARAPULSE, Boston Scientific Inc.) across a broad population of participants with paroxysmal and persistent AF. In this subanalysis, 1482 participants with symptomatic AF who were enrolled in the DISRUPT‐AF registry underwent PFA.

2.1. Eligibility

Registry data were prospectively collected from 62 operators at 17 participating sites and monitored as predefined in the protocol per the site's standard of care follow‐up. Registry design and protocol details have been previously reported [19]. Key eligibility criteria required that participants were suitable candidates and planned to undergo de novo CA with the pentaspline catheter, were ≥ 18 years old, and had a willingness to participate in baseline and follow‐up assessments per their applicable registry arm. Participants were not enrolled if they were already participating in another interventional drug/device trial without prior Sponsor's approval, had already had a left atrial surgical or CA procedure, required any inotropic or mechanical circulatory support at the time of enrollment, or if the Investigator determined that the procedure would be contraindicated. This analysis includes participants who underwent index ablation procedure with completed 90‐day follow‐up.

2.2. Data Collection and Analysis

In this subanalysis, patient and procedural data were systematically collected at baseline, the index ablation procedure, and through 90 days postprocedure. Data management for the DISRUPT‐AF data entry was performed using the 3PHCloud Electronic Data Capture (EDC) system in collaboration with Heart Rhythm Clinical Research Solutions (HRCRS) LLC. The PFA procedures were performed according to the standard of care. The protocol required that predefined reportable safety events were reported in the EDC if the investigator deemed the events to be procedure and/or device related. The reportable procedure or device‐related adverse events included atrioesophageal fistula; bleeding; significant pericardial effusion/tamponade/perforation; esophageal injury (e.g., ulceration, perforation, or erosion); pericarditis; diagnostically confirmed phrenic nerve injury/paralysis; pulmonary vein stenosis; transient ischemic attack (TIA); stroke; vagal nerve injury; vascular access complication; acute kidney injury (AKI); coronary spasm; myocardial infarction (MI); thromboembolism; all‐cause mortality or a procedure‐ or device‐related death that the investigator deemed serious and related to either the procedure or the device. Results were analyzed based on preplanned SDD and if SDD was achieved. Each operator determined the safety and feasibility of SDD based on each patient's relevant history and characteristics, as well as the anticipated workflow strategies that could impact the case complexity, such as a history of vascular disease, stroke, ejection fraction that could lengthen the procedure or add complexity. Another factor that may have influenced planning SDD was the practicality of site resourcing, which can vary across all sites, regardless of preplanning. For some operators, if a procedure was planned to start after 2 p.m., the decision was made in advance per the discretion of the operator and site's standard of care regarding patient characteristics and case complexity that SDD was not an option to ensure postprocedure safety. Other operators did not follow a 2 p.m. cut‐off to determine SDD. A successful SDD was defined as being discharged from the hospital on the same calendar day as the ablation procedure, with no need for further observation, hospitalization, or return to the emergency department within 24 h, and was deemed appropriate for discharge, evidenced by the absence of a major acute complication.

Categorical variables are presented as absolute counts and relative frequencies. Continuous variables are displayed as means with the corresponding standard deviation (SD), and 95% confidence interval (CI) levels are reported with a p‐value < 0.05 considered as statistically significant. Generalized linear mixed models with a binary distribution and logit link were used to examine associations between clinical and procedural characteristics and the likelihood of (1) planning for SDD and (2) successfully achieving SDD among those for whom it was planned. A random intercept for study site was included in all models to account for clustering by site. A sensitivity analysis was performed with the study site as a fixed effect. For the outcome of planned SDD, three models were sequentially constructed: (1) including AF classification, (2) expanding to include demographic and clinical covariates congestive heart failure/left ventricle dysfunction/hypertension/age ≥ 75 years old (doubled)/diabetes/stroke/TIA (doubled/vascular disease/age/sex) (–CHA₂DS₂‐VASc) score, body mass index (BMI), age, sex, and (3) further incorporating procedural characteristics (lesion strategy and a variable indicating whether the procedure ended after 2 p.m.). To evaluate successful SDD among those with preplanned SDD, a restricted data set was created to include only those patients for whom SDD was planned. The same modeling structure was applied: starting with AF classification alone, then including clinical covariates, and finally adding procedural characteristics. All models estimated ORs and 95% CIs, with statistical significance evaluated at the 0.05 level. All statistical analyses were performed using SPSS Statistics Software for Windows Version 26.0 (IBM Corporation, Armonk, New York), and SAS Version 9.4.

2.3. Institutional Review Board (IRB) Approval

The DISRUPT‐AF registry received central approval from WIRB‐Copernicus group IRB on March 5, 2024, and the study start date was April 4, 2024. Participating investigators and sites were required to receive IRB approval before enrolling participants. All participants provided informed consent, unless a waiver of consent was granted by the respective site's IRB. The study protocol has been amended and received IRB approval to enroll up to 10 000 participants in the United States.

3. Results

Of the total 1482 participants included in this subanalysis from July 2025, SDD was preplanned for 1203 (81.2%) participants and was not planned for 279 (18.8%) participants. Refer to Table 1 for the summary of patients planned versus unplanned. Patients who were preplanned for SDD were significantly less likely to have paroxysmal AF (52.3% vs. 64.9%, p < 0.001) and vascular disease (20.9% vs. 30.0%, p = 0.002) compared to those not preplanned for SDD. However, in an adjusted analysis specifying site as a fixed effect (see below), AF classification was not associated with the likelihood of SDD planning, suggesting the unadjusted difference by AF type reflects site‐level variation in patient case mix. Patients with planned SDD had shorter procedure times (60.6 ± 24.8 vs. 66.8 ± 22.8 min, p < 0.001), were less likely to undergo adjunctive ablation beyond PVI (81.2% vs. 95.3%, p < 0.001), and had fewer procedures initiated after 2 p.m. (11.5% vs. 21.7%, p < 0.001). Acute procedural complication rates were low in both groups (0.7% for both; p = 0.956). Similarly, there was no significant difference in 90‐day procedure‐related complications between planned and not planned SDD groups (1.5% vs. 1.8%, p = 0.719). There were no significant differences between groups in sex, age, BMI, left ventricle ejection fracture (LVEF), presence of heart failure with reduced ejection fraction (HFrEF), hypertension, prior stroke or TIA, or CHA₂DS₂‐VASc score.

Table 1.

Patient and procedural characteristics.

Patient/procedure characteristic	Total cohort (n = 1482)	SDD not planned (n = 279)	SDD planned (n = 1203)	p‐value
AF type‐paroxysmal (n, %)	810, 54.7%	181, 64.9%	629, 52.3%	< 0.001
Sex‐female (n, %)	588, 39.7%	106, 38.0%	482, 40.1%	0.524
Age (mean ± SD)	68.2 ± 11.3	67.1 ± 12.6	68.4 ± 10.9	0.094
BMI (mean ± SD)	30.7 ± 7.0	30.2 ± 7.0	30.8 ± 7.0	0.204
LVEF % (mean ± SD)	55.7 ± 10.9	55.2 ± 11.6	55.8 ± 10.7	0.501
HFrEF (n, %)	145, 9.8%	26, 9.3%	119, 9.9%	0.772
Hypertension (n, %)	909, 67.4%	174, 63.5%	735, 68.4%	0.125
Vascular disease (n, %)	312, 22.6%	75, 30.0%	237, 20.9%	0.002
History of stroke or TIA (n, %)	89, 6.6%	18, 6.6%	71, 6.6%	0.983
CHA₂DS₂‐VASc score (mean ± SD)	2.9 ± 1.6	2.8 ± 1.8	2.9 ± 1.6	0.532
Presenting rhythm: Sinus (n, %)	839, 57.9%	165, 59.6%	674, 57.6%	0.542
Procedure time in minutes (mean ± SD)	61.8 ± 24.5	66.8 ± 22.8	60.6 ± 24.8	< 0.001
Lesion strategy, PVI + (n, %)	1243, 83.9%	266, 95.3%	977, 81.2%	< 0.001
Procedure starting after 2 p.m. (n, %)	194, 13.4%	60, 21.7%	134, 11.5%	< 0.001
Acute procedure complications (n,%)	11, 0.7%	2, 0.7%	9, 0.7%	0.956
Pericarditisa	2, 0.1%	0, 0.0%	2, 0.2%
Cardiac tamponade‐pericardial effusion‐cardiac perforation	2, 0.1%	0, 0.0%	2, 0.2%
Phrenic nerve injury	1, 0.1%	0, 0.0%	1, 0.1%
Vascular access hematoma	2, 0.1%	0, 0.0%	2, 0.2%
Vascular access‐ AV fistula	1, 0.1%	1, 0.4%	0, 0.0%
Vascular access‐pseudoaneurysm	2, 0.1%	0, 0.0%	2, 0.2%
Other	1, 0.4%	1, 0.4%	0, 0.0%
Procedure‐related complications to 90 days (n, %)a	23, 1.6%	5, 1.8%	18, 1.5%	0.719
Pericarditis	5, 0.3%	0, 0.0%	5, 0.4%
Bleeding	1, 0.1%	0, 0.0%	1, 0.1%
Cardiac tamponade‐pericardial effusion‐cardiac perforation	3, 0.2%	0, 0.0%	3, 0.2%
Phrenic nerve injury	1, 0.1%	0, 0.0%	1, 0.1%
Stroke	1, 0.1%	1, 0.4%	0, 0.0%
Vascular access‐hematoma	5, 0.3%	1, 0.4%	4, 0.3%
Vascular access‐AV fistula	1, 0.1%	1, 0.4%	0, 0.0%
Vascular access‐pseudoaneurysm	4, 0.3%	1, 0.4%	3, 0.2%
Coronary spasm	1, 0.1%	0, 0.0%	1, 0.1%
Other	5, 0.3%	3, 1.1%	2, 0.2%

Abbreviations: AF, atrial fibrillation; BMI, body mass index; CHA₂DS₂‐VASc, congestive heart failure/left ventricle dysfunction/hypertension/age ≥ 75 years old (doubled)/diabetes/stroke/TIA (doubled/vascular disease/age/sex); HFrEF, heart failure with reduced ejection fracture; LVEF, left ventricle ejection fracture; PVI, pulmonary vein isolation; TIA, transit ischemic attack.

^a Complication rates are reported per patient count; some patients may have experienced > 1 event.

There was a high rate of patients who were planned for PFA‐SDD that were successfully discharged on the SDD (92.9%). Refer to Table 2 for the summary of successful versus unsuccessful outcomes. Patients with unsuccessful SDD were more likely to have a history of stroke or TIA (16.0% vs. 5.9%, p < 0.001), higher CHA₂DS₂‐VASc scores (3.6 ± 1.6 vs. 2.9 ± 1.5, p < 0.001), and were more often female (55.3% vs. 38.9%, p = 0.003). They were also older (71.0 ± 9.8 vs. 68.2 ± 11.0 years, p = 0.026). There were no significant differences in LVEF, BMI, HFrEF, hypertension, or vascular disease between groups. Patients where SDD was not successfully achieved were more likely to have procedures that started after 2 p.m. (29.3% vs. 10.1%, p < 0.001) and experienced higher rates of acute procedural complications (7.1% vs. 0.3%, p < 0.001) and 90‐day complications (8.2% vs. 1.0%, p < 0.001). Procedure duration did not differ between groups (60.6 ± 20.6 vs. 60.6 ± 25.1 min, p = 0.982), and there was no significant difference in the use of adjunctive ablation beyond PVI (91.8% vs. 80.4%, p = 0.010). Overall, there were no events of esophageal injury, atrioesophageal fistula, MI, pulmonary vein stenosis, phrenic nerve injury, AKI, coronary spasm, or device‐and procedure‐related deaths. There were two tamponade acute complication events that occurred in patients who were planned for SDD. Both patients underwent pericardiocentesis and remained in the hospital overnight for observation.

Table 2.

Patient and procedural characters for planned SDD.

Patient/procedure characteristic	Total cohort (SDD planned) (n = 1203)	SDD planned/unsuccessful (n = 85)	SDD planned/successful (n = 1118)	p‐value
AF type‐paroxysmal (n, %)	629, 52.3%	35, 41.2%	594, 53.1%	0.033
Sex‐female (n, %)	482, 40.1%	47, 55.3%	435, 38.9%	0.003
Age (mean ± SD)	68.4 ± 10.9	71.0 ± 9.8	68.2 ± 11.0	0.026
BMI (mean ± SD)	30.8 ± 7.0	31.5 ± 8.8	30.8 ± 6.9	0.432
LVEF % (mean ± SD)	55.8 ± 10.7	52.7 ± 13.6	56.0 ± 10.4	0.063
HFrEF (n, %)	119, 9.9%	12, 14.1%	107, 9.6%	0.176
Hypertension (n, %)	735, 68.4%	46, 61.3%	689, 68.9%	0.174
Vascular disease (n, %)	237, 20.9%	22, 26.8%	215, 20.5%	0.172
History of stroke or TIA (n, %)	71, 6.6%	12, 16.0%	59, 5.9%	< 0.001
CHA₂DS₂‐VASc score (mean ± SD)	2.9 ± 1.6	3.6 ± 1.6	2.9 ± 1.5	< 0.001
Presenting rhythm: Sinus (n, %)	674, 57.6%	39, 47.6%	635, 58.3%	0.058
Procedure time in minutes (mean ± SD)	60.6 ± 24.8	60.6 ± 20.6	60.6 ± 25.1	0.982
Lesion strategy, PVI+ (n, %)	977, 81.2%	78, 91.8%	899, 80.4%	0.010
Procedure starting after 2 p.m. (n, %)	134, 11.5%	24, 29.3%	110, 10.1%	< 0.001
Acute procedure complications (n, %)a	9, 0.7%	6, 7.1%	3, 0.3%	< 0.001
Pericarditis	2, 0.2%	0, 0.0%	2, 0.2%
Cardiac tamponade‐pericardial effusion‐cardiac perforation	2, 0.2%	2, 2.4%	0, 0.0%
Phrenic nerve injury	1, 0.1%	0, 0.0%	1, 0.1%
Vascular access‐ hematoma	2, 0.2%	2, 2.4%	0, 0.0%
Vascular access‐ pseudoaneurysm	2, 0.2%	2, 2.4%	0, 0.0%
Procedure‐related complications to 90 days (n, %)a	18, 1.5%	7, 8.2%	11, 1.0%	< 0.001
Pericarditis	5, 0.4%	0, 0.0%	5, 0.4%
Bleeding	1, 0.1%	0, 0.0%	1, 0.1%
Cardiac tamponade/pericardial effusion/cardiac perforation	3, 0.2%	2, 2.4%	1, 0.1%
Phrenic nerve injury	1, 0.1%	0, 0.0%	1, 0.1%
Vascular access‐ hematoma	4, 0.3%	2, 2.4%	2, 0.2%
Vascular access‐ pseudoaneurysm	3, 0.2%	2, 2.4%	1, 0.1%
Coronary spasm	1, 0.1%	0, 0.0%	1, 0.1%
Other	2, 0.2%	1, 1.2%	2, 0.2%

Abbreviations: AF, atrial fibrillation; BMI, body mass index; CHA₂DS₂‐VASc, congestive heart failure/left ventricle dysfunction/hypertension/age ≥ 75 years old (doubled)/diabetes/stroke/TIA (doubled/vascular disease/age/sex); HFrEF, heart failure with reduced ejection fracture; LVEF, left ventricle ejection fracture; PVI, pulmonary vein isolation; TIA, transit ischemic attack.

^a Complication rates are reported per patient count; some patients may have experienced > 1 event.

In the adjusted model for site random effects evaluating planned SDD including patient characteristics only, higher CHA₂DS₂‐VASc score was significantly associated with lower odds of planning for SDD (OR: 1.30, 95% CI: 1.10–1.53, p = 0.002), as was older age (OR: 0.976, 95% CI: 0.954–0.998, p = 0.033). Sex, BMI, and AF classification were not significantly associated with the planning decision. In the primary model incorporating procedural variables, the association with CHA₂DS₂‐VASc remained significant (OR: 1.27, 95% CI: 1.07–1.51, p = 0.005). Procedures starting after 2 p.m. were associated with a more than two‐fold increase in the odds of not planning for SDD (OR: 2.47, 95% CI: 1.38–4.43, p = 0.002). Neither ablation strategy nor any of the patient demographic variables were associated with planned SDD.

Among patients with preplanned SDD, higher CHA₂DS₂‐VASc score remained significantly associated with failed discharge on the same day in adjusted models for patient characteristics. In the model including patient factors alone, CHA₂DS₂‐VASc was associated with increased odds of unsuccessful SDD (OR: 1.24, 95% CI: 1.02–1.49, p = 0.027). There were no significant associations with age, sex, BMI, and AF classification. In the primary model evaluating successful SDD including procedural variables, CHA₂DS₂‐VASc remained significant (OR: 1.29, 95% CI: 1.06–1.57, p = 0.010), and procedure start time after 2 p.m. was strongly associated with unsuccessful SDD (OR: 3.63, 95% CI: 2.06–6.39, p < 0.001). In contrast, undergoing pulmonary vein isolation (PVI) without additional lesion sets was associated with increased odds of successful SDD (OR: 2.37, 95% CI: 1.01–5.58, p = 0.048). There were no significant associations with age, sex, or BMI. Figure 1 displays the estimates from the primary adjusted models.

Figure 1.

Forrest plots for adjusted analyses. Legend: The OR results for SDD unplanned and SDD unsuccessful.

4. Discussion

In this subanalysis of the DISRUPT‐AF Registry, we report a high rate of success for preplanned SDD with the pentaspline PFA catheter. Out of the 1482 patients consecutively enrolled, 92.9% achieved successful PFA‐SDD. Of the 7.1% (85/1203) of preplanned SDD cases that did not meet this objective, 7.2% (6/85) of those patients experienced an acute procedural complication compared to 0.3% (3/1118, p < 0.001) of patients that had successful PFA‐SDD. Procedural complications were infrequent across the DISRUPT‐AF Registry cohort (0.7%, 11/1482), with no significant difference observed between patients with planned SDD and those without (0.7% vs. 0.7%, p = 0.956).

Procedure duration, starting after 2 p.m., and having adjunctive ablation beyond PVI were significantly different if SDD was preplanned or not, suggesting that careful case planning may contribute to SDD success. Our analysis demonstrates that PFA‐SDD is safe and feasible in a real‐world, large multicenter registry, with an overall success rate of 92.9% among planned cases. This high rate of success supports broader adoption of SDD strategies in appropriately selected participants undergoing PFA. Shorter procedure times and morning start times were strongly associated with SDD planning, reflecting the importance of logistical factors in discharge decision‐making. Additionally, participants undergoing only PVI were more likely to be discharged the same day, likely due to reduced procedural complexity.

Importantly, when SDD was planned but not achieved, those cases were associated with clinical risk factors of prior stroke/TIA, higher CHA₂DS₂‐VASc scores, female sex, older age, and impaired left ventricle function. These findings emphasize the importance of preprocedural risk stratification and postprocedural observation in select participants. This data suggests that with proper planning and triage, PFA‐SDD can be implemented safely in a real‐world setting to treat AF with the pentaspline PFA catheter.

This study builds upon other real‐world data evaluating SDD after PFA. In a recent single‐site study, patients undergoing ablation to treat AF underwent treatment with the FARAPULSE PFA system (n = 955) or radiofrequency ablation (RFA) (n = 1072) and were compared to evaluate the safety of SDD [20]. Patients treated with PFA had a higher rate (21.68%, 207/955) of SDD compared to RFA (11.85%, 127/1072) and major complications were low for both arms. The predictors for SDD after PFA were the CHADVASC score, coronary artery disease, ≥ 80 years old, and the procedure duration [20]. In a prior real‐world registry, survey results from 90 operators from multiple centers across Europe reported that SDD occurred at a rate of 15.1% of the total 1758 treated participants undergoing CA [21]. In a survey conducted by the Heart Rhythm Society, 705 electrophysiologists responded (94% were from the United States) and reported that SDD occurs in 73%–74% AF ablation cases and 45%–46% believed AF ablation could be safely performed in an ASC [12].

In a different study, physicians reported from two Canadian sites that the SDD rate was 90.5% (381/421) and 1% of those participants experienced a complication within 24 h postprocedure, but subsequent emergency room visits within 30 days were high for both RFA and cryoballoon ablation (CBA) treated participants (26.1%–28%), respectively [22]. In a real‐world registry based at multiple sites in the United States, 86.1% (1982/2332) of participants met the prespecified SDD‐eligible requirements (e.g., stable anticoagulation, ejection fraction > 40%, etc.) and had lower rates of acute complications [23]. Hospital readmission rates significantly differed between SDD and non‐SDD participants (0.8% vs. 0.9%, p = 0.924% and 0.8% vs. 2.9%, p = 0.001, respectively) [23].

Furthermore, multiple studies have also reported the potential for PFA procedures to reduce healthcare burden from shortened procedure times. When compared to conventional thermal energy ablation techniques, PFA has been shown to significantly reduce the burden of healthcare resource utilization [24]. In a large meta‐analysis performed by the European Heart Rhythm Association Health Economics Committee, SDD after AF ablation showed that periprocedural and 30‐day follow‐up complication rates were rare, as well as low rehospitalization and emergency room visits when compared to the overnight stay group [13]. In one single‐center analysis comparing outcomes after ablation with the FARAPULSE system versus thermal ablation showed significantly reduced procedure times with the PFA, which may help daily procedures increase to offset the additional cost of the PFA system [25]. The recent Heart Rhythm Society/American College of Cardiology statement on SDD for ablation procedures noted that SDD strategies are one of the most important factors to ensure increased access to electrophysiologist services and also reduces facility operating costs from overnight stays [26]. In addition, the option to perform PFA in an ASC is also becoming an option that may also reduce facility and patient costs, as well as increase access to more patients.

The outcomes for previous SDD ablation studies are varied and could be impacted by operator experience, geographic region, COVID lockdown, case volume, the size and type of site, and type of healthcare system (e.g., national health plans, private insurance, etc.). Additional logistical factors to consider include the participant's travel distance, operator case schedule, procedure start time, lack of inpatient beds or staff, and poor implementation of an SDD protocol [27]. The National Cardiovascular Data Registry (NCDR) reported SDDs increased from 0.99% to 62.3% between 2016 and 2023, which includes the use of PFA catheters, amplifying the importance of understanding SDD as new technology is introduced [28]. Artificial intelligence is being explored to develop predictive models for optimal participant selection for future SDD and still requires further refinement to show positive predictive results [29]. Thus, understanding patient and procedural characteristics associated with SDD outcomes may further help innovation that can improve safety and increase benefits for patients. Additional research is needed to determine risk factors for PFA, as they may not be consistent with other more established ablation modalities.

5. Conclusion

In the DISRUPT‐AF Registry de novo cases, PFA‐SDD has been widely implemented and successfully completed in the majority of preplanned SDD cases. SDD was achieved less frequently in cases with higher clinical risk and procedural complications. These findings support preplanned PFA‐SDD is a safe and feasible strategy to treat paroxysmal AF with the pentaspline catheter.

Ethics Statement

The Western Institutional Review Board (WIRB) provides approval and oversite.

Consent

The study was approved by the Institutional Review Board. Patients are prospectively consented with a patient‐informed consent form (ICF) approved by the Institutional Review Board/Ethics Committee.

Conflicts of Interest

Amin Al‐Ahmad provides consulting for Boston Scientific; Jose Osorio provides consulting with Boston Scientific; FrankCuoco provides consulting for Boston Scientific; John Day Consulting and research from Johnson & Johnson MedTech, Boston Scientific and Medtronic; Joshua Silverstein provides consulting with Johnson and Johnson MedTech, Medtronic, and Impulse Dynamics; Anil Rajendra provides consulting for Boston Scientific and Johnson & Johnson MedTech; and Andrea Natale reports research and consulting with Abbott, Biosense Webster, Biotronik, Boston Scientific, iRhythm, Field Medical, Haemonetics, Medtronic, and Pulse Bioselect.

Al‐Ahmad A., Osorio J., Day J., et al., “Patient and Procedural Factors Associated With Same‐Day Discharge Following Pulsed Field Ablation for Atrial Fibrillation: Insights From the DISRUPT‐AF Registry,” Journal of Cardiovascular Electrophysiology 37 (2026): 149‐156. 10.1111/jce.70210.

Data Availability Statement

Data and reprints are available upon request.