SHARE @ Advocate Health - Midwest - Scientific Day: Learning Curves in Pulsed Field Ablation: Implementation in Academic and Non-Academic Centers
 

Affiliations

Aurora Sinai Medical Center, Aurora St. Luke's Medical Center

Abstract

Background/Significance:

Atrial fibrillation (AF) is a common arrhythmia that increases risk for stroke when left untreated. The standard treatment for AF includes ablation to achieve pulmonary vein isolation (PVI). Pulsed field ablation (PFA) is a novel modality for PVI in patients with AF, recently introduced in the US.

Purpose:

We sought to evaluate differences in baseline and procedure characteristics, complications, and PFA implementation learning curves in academic versus non-academic centers to determine if learners may impact the aforementioned.

Methods:

Data on AF patients treated with PFA during a three-month period at two academic centers and one non-academic center were collected. Baseline and procedure characteristics were compared. Continuous variables are presented as median (Q1, Q3). Categorical variables are presented as n (%). For categorical variables, either chi-square test or Fisher’s exact test was used. For the numeric variables, the Wilcoxon Rank Sum test was used. Learning curve slopes for procedure and fluoroscopy time were compared using regression analysis.

Results:

Overall (n=147), the non-academic cohort (n=34) had significantly younger patients (years) 63.7 (56.7, 66.8) vs. 68 (61.7, 73.2), P=0.0085, smaller LA volume index (ml/m2) 30 (18.0, 37.5) vs. 35.4 (28.1, 46.0), P=0.0198, lower CHA2DS2-VASc score, 2 (1,2) vs. 3 (2,4) P=0.0018, and fewer patients with coronary artery disease, 3 (8.8) vs. 32 (28.3), P=0.0193, and diastolic dysfunction, 4 (17.4) vs. 37 (40.7), P=0.0378. There were no significant differences in sex, body mass index, prior stroke, left ventricular ejection fraction, or obstructive sleep apnea (P>0.05). Non-academic centers gave PVI plus additional lesions more often, 34 (100), than academic 61 (54.0) (P< 0.0001). The non-academic center had significantly lower procedure time (min) 46 (36.0, 66.0) vs. 119 (94.0, 149.3) and fluoroscopy use (min) 11.5 (7.5, 17.1) vs. 23.1 (15.6, 35.6) (P< 0.0001). The thirty-day complication rate was similar in non-academic, 3 (8.8) and academic, 3 (2.6) centers (P=0.1367). There was no difference in the slope of learning curve by procedure time (P=0.8907) or by fluoroscopy duration (P=0.9761) between cohorts.

Conclusion:

In the implementation of PFA as a new PVI modality, there was no learning curve observed in academic or non-academic centers. Procedure complications in academic centers were low despite the use of physician trainees and sicker patients.

Presentation Notes

Presented at Scientific Day; May 21, 2025; Park Ridge, IL.

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May 21st, 1:43 PM May 21st, 1:56 PM

Learning Curves in Pulsed Field Ablation: Implementation in Academic and Non-Academic Centers

Background/Significance:

Atrial fibrillation (AF) is a common arrhythmia that increases risk for stroke when left untreated. The standard treatment for AF includes ablation to achieve pulmonary vein isolation (PVI). Pulsed field ablation (PFA) is a novel modality for PVI in patients with AF, recently introduced in the US.

Purpose:

We sought to evaluate differences in baseline and procedure characteristics, complications, and PFA implementation learning curves in academic versus non-academic centers to determine if learners may impact the aforementioned.

Methods:

Data on AF patients treated with PFA during a three-month period at two academic centers and one non-academic center were collected. Baseline and procedure characteristics were compared. Continuous variables are presented as median (Q1, Q3). Categorical variables are presented as n (%). For categorical variables, either chi-square test or Fisher’s exact test was used. For the numeric variables, the Wilcoxon Rank Sum test was used. Learning curve slopes for procedure and fluoroscopy time were compared using regression analysis.

Results:

Overall (n=147), the non-academic cohort (n=34) had significantly younger patients (years) 63.7 (56.7, 66.8) vs. 68 (61.7, 73.2), P=0.0085, smaller LA volume index (ml/m2) 30 (18.0, 37.5) vs. 35.4 (28.1, 46.0), P=0.0198, lower CHA2DS2-VASc score, 2 (1,2) vs. 3 (2,4) P=0.0018, and fewer patients with coronary artery disease, 3 (8.8) vs. 32 (28.3), P=0.0193, and diastolic dysfunction, 4 (17.4) vs. 37 (40.7), P=0.0378. There were no significant differences in sex, body mass index, prior stroke, left ventricular ejection fraction, or obstructive sleep apnea (P>0.05). Non-academic centers gave PVI plus additional lesions more often, 34 (100), than academic 61 (54.0) (P< 0.0001). The non-academic center had significantly lower procedure time (min) 46 (36.0, 66.0) vs. 119 (94.0, 149.3) and fluoroscopy use (min) 11.5 (7.5, 17.1) vs. 23.1 (15.6, 35.6) (P< 0.0001). The thirty-day complication rate was similar in non-academic, 3 (8.8) and academic, 3 (2.6) centers (P=0.1367). There was no difference in the slope of learning curve by procedure time (P=0.8907) or by fluoroscopy duration (P=0.9761) between cohorts.

Conclusion:

In the implementation of PFA as a new PVI modality, there was no learning curve observed in academic or non-academic centers. Procedure complications in academic centers were low despite the use of physician trainees and sicker patients.

 

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