Quick Dive: Same-day discharge after EP and CIED procedures

Prof. Daniel Scherr, Medical University of Graz, Austria

Dr. Julia Vogler, Asklepios Klinik St. Georg, Hamburg, Germany

What is the reason for and aim of the publication?

Differences in national reimbursement structures, institutional infrastructure, medical and legal frameworks, staffing models, and local culture toward ambulatory cardiovascular care contribute to considerable variation in same-day discharge (SDD) implementation between centers and countries in Europe. The new consensus document seeks to address this gap. Beyond summarizing the available scientific evidence, the primary intent of this document is practical. By mapping the complete patient pathway – from pre-procedural risk assessment and intra-procedural optimization to post-discharge surveillance, remote monitoring, and institutional implementation – it aims to provide clinicians, especially those who are beginners in SDD practice, with directly applicable advice to support the safe, reproducible, and wider adoption of SDD for electrophysiological (EP) and cardiac implantable electronic device (CIED) procedures across diverse European healthcare environments.

What are the most important take-home messages?

• Based on current evidence, SDD after CIED and EP procedures is safe in appropriately selected patients.
• Complication rates and readmission rates are not elevated in SDD compared to overnight stay procedures (ONS).
• Patients with stable physical and mental conditions undergoing SVT or AF ablation are ideal candidates for SDD ablation.
• Every CIED procedure may in principle be performed as an SDD procedure except for transvenous lead extractions.
• There are no absolute contraindications for SDD. The final decision on SDD is at the discretion of the treating physicians or a multidisciplinary team, taking into account relevant comorbidities, potential procedural or clinical risk factors, and social considerations such as proximity to the hospital and availability of adequate support at home.

What are challenges in practical implementation – and possible solutions?

Currently, there are several barriers to wider adoption and implementation of SDD within Europe. There are still political barriers in some European countries which impede SDD implementation, but there are also restraints from physicians and patients who are afraid of potential complications following SDD procedures. The latter can be solved by education and gradual implementation of SDD to reassure skeptical physicians and patients. On a more practical level, hospitals may face organizational obstacles which make streamlined SDD procedures difficult. These can be solved by implementation of dedicated day care units and standardized processes.

Which issues still need to be tackled, that are not yet addressed by the paper?

There are still gaps in evidence that need to be addressed, including:

• Limited evidence from randomized controlled trials (RCTs) and heterogeneous definitions
• Personalized risk stratification
• Late and infrequent complications
• Post-discharge monitoring strategies
• Health economics
• Patient experience and equity
• Standardization and collaborative registries
• Digital tools and dynamic risk models
• Education and training in SDD centers

What further developments on the topic are emerging?

Due to limited healthcare resources on one hand and technological advancements on the other, the number of SDD EP and CIED procedures will increase over the next years and will become the new standard. Developments as currently seen in the US – such as a shift from in-hospital procedures to procedures performed in ambulatory surgical centers which do not provide the same infrastructure as hospitals – will emerge in Europe and will require further adaptations.

Same-day discharge after electrophysiological and cardiac implantable electronic device procedures

Scherr D, Frausing MHJP, Maciejewski C, et al. Same-day discharge after electrophysiological and cardiac implantable electronic device procedures: a clinical consensus statement of the European Heart Rhythm Association (EHRA) and the Association of Cardiovascular Nursing & Allied Professions (ACNAP) of the ESC. Europace. 2026;28(4):euag065. doi:10.1093/europace/euag065.

Document types published by the ESC, Associations, Councils, Working Groups, and ESC Committees (according to the ESC Scientific Documents Policy):