Background:

Pulsed field ablation (PFA) has recently been introduced as a novel routine ablation technology for paroxysmal atrial fibrillation (PAF). Only very limited data on learning curves after implementing this new technique in clinical practice exist. We present data from our experience with learning curves using pulsed field ablation for atrial fibrillation.

Methods:

In patients with paroxysmal or persistent AF, PVI in conscious sedation using a steerable sheath and a pentaspline over-the-wire basket and flower PFA catheter was performed. No 3D mapping system was used. Total procedure time, left atrial (LA) dwell time, time from first to last ablation and fluoroscopy time were analysed over the course of time. First and last chronological tertiles of each parameter were compared for statistical significance.

Results:

This study included a total of 147 patients (mean age: 66±10 years; 41% female). Mean CHA₂DS₂-VASc-score was 2,4±1,5. The procedures were performed by 4 operators (3 DGK certified EP specialists and 1 EP fellow) in random teams of 2 operators. Median skin-to skin procedure time was 47 [40;61] min. There was a statistically significant decrease between the first and last tertiles: 53 [44;68] vs. 46 [41;54] min (p<0,01). Median LA dwell time of the PFA catheter was 37 [31;47] min. There was a statistically significant decrease between the first and last tertiles: 41 [34;53] vs. 38 [32;45] min (p<0,05). Median time from first to last ablation was 23 [20;30] min. There was no statistically significant decrease between the first and last tertiles: 23 [20;28] vs. 27 [20;31] min (p=ns). Median fluoroscopy time was 16 [12;19] min. There was a statistically significant decrease between the first and last tertiles: 17 [13;21] vs. 17 [12;19] min (p<0,05).

Conclusions:

The introduction of a novel pulsed field ablation system for pulmonary vein isolation used by 4 operators leads to a significant decrease in total procedure time, LA dwell time and fluoroscopy time over the course of time, demonstrating streamlining of the ablation procedure as a whole. Time from first to last ablation remains constant, this is probably due to the standardized protocol of the ablation itself.

Figure:

The slope of the procedure time is steeper than the slope of the LA dwell time and ablation time, indicating the the streamlining of the process during the course of time.