Arrhythmias & electrophysiology
Learning curve and procedural efficiency of zero-fluoroscopy pulsed-field ablation for atrial fibrillation
Authors' conclusion
Zero-fluoroscopy PFA is safe and effective, with comparable acute procedural outcomes and safety profile with zero-fluoroscopy RFA. The zero-fluoroscopy PFA learning curve is independent of career stage or physician.
Study context
- Population
- Patients undergoing zero-fluoroscopy first-time ablation for atrial fibrillation with pulmonary vein isolation (PVI) or PVI with PWI lesion sets, January 2022 to March 2025
- Participants
- 827 consecutive zero-fluoroscopy first-time ablations
- Comparison
- Zero-fluoroscopy RFA and PFA pulmonary vein isolation
- Outcome
- Procedure time vs fluoroscopy-guided procedures
Methodological detailsconsecutive first-time ablations, high-volume academic institution, mixed-effects regression models
- Consecutive first-time ablations
- High-volume academic institution
- Mixed-effects regression models
Main finding
As reported in the abstract
Zero-fluoroscopy RFA shorter than fluoroscopy-guided procedures
25 minutes
Zero-fluoroscopy PFA shorter than fluoroscopy-guided procedures
14 minutes
Further findings
| Outcome | Difference (minutes) | P value |
|---|---|---|
| Zero-fluoroscopy procedure time, PFA vs RFAPFA vs RFA · overall; reduced with PFA | −25 | P < 0.001 |
| Zero-fluoroscopy procedure time, PFA vs RFAPFA vs RFA · PVI | −16 | P < 0.001 |
| Zero-fluoroscopy procedure time, PFA vs RFAPFA vs RFA · PVI + PWI | −28 | P < 0.001 |
Baseline characteristics
- Mean age
- 65 ± 10 years
- Male
- 68%
- Paroxysmal atrial fibrillation
- 54%
Learning curve for zero-fluoroscopy PFA
- Plateaued after total PFA cases
- 114
- Reduction in procedure time per additional PFA case
- 0.5 minutes
- Did not vary by physician or years of experience
- Mixed-effects model analysis
- P < .001
Safety
- Severe complications
- 0.48%
- No significant difference between energy types
Original publication
Learning curve and procedural efficiency of zero-fluoroscopy pulsed-field ablation for atrial fibrillation. Heart Rhythm. Published 18 September 2025. doi:10.
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