Optimising the atrial fibrillation ablation pathway using vascular closure devices: effects on length of stay, procedure time and outcomes

BACKGROUND: The rising prevalence of atrial fibrillation has led to increasing the numbers of pulmonary vein isolations. Optimising care pathway efficiency is essential for sustainable healthcare delivery. This study aimed to evaluate the impact of closure devices (CD) within the care pathway on hospital stay, patient satisfaction, staff workload, and costs, following catheter ablation for atrial fibrillation. METHODS: This study compared the standard care pathway following catheter ablation using manual compression (MC, December 2023-February 2024) to a modified pathway incorporating suture-mediated CD (March-May 2024). Primary outcomes included process indicators (e.g., hospitalisation duration), clinical outcomes (e.g., bleeding complications), and patient experience. Secondary outcomes included staff experience and healthcare costs associated with procedural changes. RESULTS: A total of 159 patients participated (MC: 81 patients, CD: 78 patients). Patients received an average of 2 percutaneous sutures. Treatment with CDs resulted in a 3.7-hour reduction in hospitalisation duration (p <. 001), 10-minute shorter procedure time in first-time ablations (p = .006), and 4‑hour shorter bed rest (p <. 001). Patients experienced less pain, measured using the Numeric Rating Scale (median 3 vs 1, p = .001), and used less pain medication (p = .006). Discharge comfort was higher in the CD group (p = .009), while complication rates remained similar. 24 nurses participated in the questionnaire. Most nurses reported improved time efficiency and workday organisation. Costs were similar across groups. CONCLUSION: CDs improve care pathways after atrial fibrillation ablation by reducing hospitalisation time, enhancing patient comfort, and improving workflow efficiency without increasing complications.