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Reply to Letter: Assessing the risk of postprocedural complications on same‐day discharge in patients with atrial fibrillation

First of all, we would like to thank Dr. Tong, Jiang, and Yang for their interest in our study on the low incidence of major complications after the first 6 h post‐AF‐ablation, and for their thoughtful comments. The main purpose of this study was to analyze the number of actual complications that occurred during the time span 6 h postprocedure and until discharge (the day after ablation procedure), that is, complications that would have occurred after discharge, if same‐ day discharge had been applied. Our main result and our conclusion were that there are few major complications in the time span 6–24 h postablation. The declining incidence of complications further supports our conclusion regarding the safety of same‐day discharge. When comparing baseline data between the cohort 2010–2015 (n = 1968) and 2016–2020 (n = 2292) we found significant differences in age (mean ± SD); (59.3 ± 9.6 vs. 61.5 ± 10.4, p < .001), procedure duration (min); (183 ± 64 vs. 163 ± 50, p < .001), paroxysmal AF (64.6% vs. 53.1%, p < .001), first time procedure (63.6% vs. 69.3%, p < .001), and cryoablation compared to RF (14.7% vs. 1.2%, p < .001). In summary, the last 5 years the patients were older, more were persistent AF, there were fewer repeat ablations, fewer cryoablation, and shorter procedure time. Although we used prospectively collected data for complications, we did not have the exact time‐data (only the intervals intraprocedural to 6 h postprocedure and 6–24 h postprocedure) for calculating the hazard ratio and hence we performed the logistic regression analysis. We agree that the technologies in the AF‐ablation field have evolved substantially during the last 5 years, and this, in addition to increased clinical experience in AF ablation, is likely to contribute to the decline in complications and not a patient selection with less comorbidities. Regarding the suggestion of propensity‐score matched analysis, we cannot see the value of this. All patients received the same treatment, that is, pulmonary vein isolation, although the techniques have varied throughout the study period. The propensity score is useful to get a matched control group for balancing two groups upon an independent variable, and not upon the dependent variable (major complication within 24 h) and thus not applicable for our analysis as all our patients were in the treatment group.