Arrhythmias & electrophysiology
Beyond the learning curve: How operator experience affects pulsed-field ablation outcomes
Authors' conclusion
Although the learning curve for "single-shot" PFA is approximately 20 cases per operator based on procedure and fluoroscopy times, improvements in long-term PVI durability were observed after 60 cases. No difference in freedom from arrhythmia was observed during the learning curve or by using 3D-EAM.
Study context
- Population
- Patients with atrial fibrillation undergoing their first PVI using PFA3D-EAM used in 457 patients (45%)
- Participants
- 1,008 patients
- Comparison
- During vs after the learning curve; with vs without 3D-EAM
- During the learning curven = 224
- After the learning curven = 784
- With 3D-EAMn = 457
- Outcome
- Learning curve (exponential fit)
Main finding
As reported in the abstract
Procedure time, procedures per operator
18
Fluoroscopy time, procedures per operator
8
Further findings
| Outcome | During the learning curve | After the learning curve | Without 3D-EAM | With 3D-EAM |
|---|---|---|---|---|
| Freedom from arrhythmia recurrence · 12 months | 65% | 68% | — not stated in the abstract | — not stated in the abstract |
| Freedom from arrhythmia recurrence by 3D-EAM use · 12 months | — not stated in the abstract | — not stated in the abstract | 69% | 64% |
— not stated in the abstract
- Freedom from arrhythmia recurrence: P = .52
- Freedom from arrhythmia recurrence by 3D-EAM use: P = .50
- PVI durability at repeat ablation: <60 procedures per operator 61%
- PVI durability at repeat ablation: thereafter 73%
- PVI durability at repeat ablation: P = .017
Original publication
Beyond the learning curve: How operator experience affects pulsed-field ablation outcomes. Heart Rhythm. Published 4 September 2025. doi:10.
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