What is the clinical evidence from this study?

Study design: Cohort. Population: Paroxysmal atrial fibrillation (n=290). Intervention: Zero-fluoroscopy pulmonary vein isolation at community hospitals vs. Zero-fluoroscopy pulmonary vein isolation at tertiary hospitals. Primary outcome: Atrial fibrillation recurrence at 12 months (p=<0.010).

What question did this study set out to answer?

To evaluate the long-term safety and effectiveness of paroxysmal atrial fibrillation ablation at community hospitals.

March 31, 2026

Safety and effectiveness of zero-fluoroscopy atrial fibrillation ablation in community hospitals vs tertiary centers

Q: What are the key findings of this study?

Zero-fluoroscopy ablation of paroxysmal atrial fibrillation at community hospitals resulted in lower AF recurrence at 12 months compared to tertiary hospitals (17% vs. 29%, p<0.010).

Q: What question did this study set out to answer?

To evaluate the long-term safety and effectiveness of paroxysmal atrial fibrillation ablation at community hospitals.

Key Result

Zero-fluoroscopy ablation of paroxysmal atrial fibrillation at community hospitals resulted in lower AF recurrence at 12 months compared to tertiary hospitals (17% vs. 29%, p<0.010).

Key Points

To evaluate the long-term safety and effectiveness of paroxysmal atrial fibrillation ablation at community hospitals.
Retrospective analysis of patients from two community hospitals undergoing zero-fluoroscopy pulmonary vein isolation.
Matched cohorts of 290 patients based on propensity score matching, followed for 24 months.
Event monitors and self-wearable cardiac devices used for follow-up.
No intraprocedural complications reported in either cohort.
Community hospital patients had lower atrial fibrillation recurrence at 12 months (17% vs. 29%, p<0.010) and shorter diagnosis-to-ablation time (6.1±1.2 months vs. 12.4±2.5 months, p<0.01).
Repeat ablation was significantly higher in tertiary hospital patients (27% vs. 7%, p<0.01).

Study Design

Type

Cohort (n=290)

Multicenter

Yes

Structured PICO

Does zero-fluoroscopy pulmonary vein isolation at community hospitals improve outcomes compared to tertiary hospitals in patients with paroxysmal atrial fibrillation?

Population

290 propensity score-matched patients with paroxysmal atrial fibrillation (mean age 66 ± 5 years; 70% male; CHA2DS2-VASc score 1 ± 2; EF 55%)

Intervention

Zero-fluoroscopy pulmonary vein isolation at community hospitals (2017-2021)

Comparator

Zero-fluoroscopy pulmonary vein isolation at a tertiary hospital (2015-2017)

Outcome

Atrial fibrillation recurrence at 12, 18, and 24 monthshard clinical

Zero-fluoroscopy ablation of paroxysmal atrial fibrillation at community hospitals is safe and associated with shorter diagnosis-to-ablation times and lower early AF recurrence compared to tertiary centers.

Main Result

Absolute Event Rate: 17% vs 29%

p-value: p=<0.010

Abstract

BACKGROUND Catheter ablation of atrial fibrillation (AF) is primarily performed at tertiary hospitals (THs). The safety and effectiveness of AF ablation at community hospitals (CHs) remains unclear. OBJECTIVE To assess the long-term efficacy and safety of paroxysmal AF (PAF) ablation at CHs. METHODS We retrospectively analyzed patients evaluated at 2 CHs who underwent zero-fluoroscopy (ZF) pulmonary vein isolation (PVI) at a TH (2015 - 2017) with those ablated at CHs (2017-2021) after implementation of a local ablation program. Patients were followed up for 24 months (m) with event monitors and self-wearable cardiac monitoring devices. Propensity score matching (PSM) yielded two matched cohorts of 290 patients (mean age 66 ± 5 years; 70% male; CHA2DS2-VASc score 1 ± 2; EF 55%). RESULTS No intraprocedural complications or transfers occurred. CH patients had lower AF recurrence at 12 and 18 m (17% vs. 29%, p9 m (HR 3.7; 95% CI, 2.30-3.75) compared with <3 m. CONCLUSIONS Ablation of PAF at CHs with ZF is safe with a shorter DAB and decrease AF recurrences when compared with TH.

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