Background: Single-shot devices for pulmonary vein isolation (PVI) are commonly used for atrial fibrillation ablation. Evolution of procedure and fluoroscopy times as a surrogate for learning curves are often analyzed per center and not per individual operator. We compared individual operator learning curves for pulsed field ablation (PFA) using the pentaspline catheter versus cryoballoon ablation.
Methods: We analyzed consecutive PVI procedures performed by operators starting their experience with single-shot devices. Only operators who started their single shot PVI experience at our center and who now have performed at least 50 procedures with both compared technologies were included. A total of 346 PFA and 517 cryoballoon procedures performed by 5 different operators were analyzed. Evolution of procedure and fluoroscopy times was assessed and segmented linear regression was used to estimate learning cutoffs.
Results: Mean procedure and fluoroscopy times were shorter with PFA than with cryoballoon: 36.5 vs. 56 minutes (procedure) and 9.33 vs. 10.6 minutes (fluoroscopy). Segmented regression indicated faster learning with PFA, with cutoff points at 27 procedures (procedure time) and 26 procedures (fluoroscopy time), compared with 87 and 85 procedures for cryoballoon, respectively. The evolution of mean procedure and fluoroscopy times of the operators are illustrated with LOESS-smoothed trends and segmented regression cutoff points for each technology (Figure 1).
Conclusions: Pulmonary vein isolation with PFA using the pentaspline catheter is associated with significantly shorter procedure and fluoroscopy times compared with cryoballoon ablation. New operators reach procedural proficiency substantially faster with PFA, as reflected by lower learning curve cutoff points. These findings support the efficiency and rapid learnability of PFA for PVI.
