AF ablation by high-volume operators (≥50 cases/year) was associated with greater freedom from AF recurrence at 1 year compared to low-volume operators (HR 1.73; 95% CI 1.23-2.48; P=0.002).
Cohort (n=471)
Yes
Does catheter ablation by a high-volume operator improve freedom from AF recurrence and reduce complications in patients with paroxysmal AF compared to low-volume operators?
Even within high-volume centers, individual operator proficiency (≥50 cases/year) significantly improves AF ablation success rates and reduces major complications.
Effect estimate: HR 1.73 (95% CI 1.23-2.48)
Absolute Event Rate: 76.4% vs 62.8%
p-value: p=0.002
AIMS: A worldwide survey reported that the success rate of atrial fibrillation (AF) ablation was higher in high-volume centers compared with low-volume centers. We tested whether the procedure volume of each operator was associated with the outcome of AF ablation in high-volume centres. METHODS AND RESULTS: We studied 471 patients with paroxysmal AF who underwent pulmonary vein (PV) isolation for the first time in three cardiovascular centers where the annual AF ablation volume was >100 procedures. We classified a total of 10 primary operators according to their operation volume on the basis of ACC/AHA/ACP CLINICAL COMPETENCE STATEMENT; high-volume operator (≥50 cases/year, N = 3) or low-volume operator (<50 cases/year, N = 7). The patients included were dichotomized according to the annual operation volume of their attending physician. The endpoints were the freedom from AF recurrence 1 year after the ablation, major complications including thromboembolisms, massive bleeding or death, and the procedural duration. RESULTS: A complete isolation of the four PVs was achieved in 99.1%. The freedom from AF recurrence was more common in patients treated by high-volume operators than those treated by low-volume operators (165/216 76.4% vs. 160/255 62.8%; P = 0.001). A high-volume operator was the only independent predictor of the freedom from AF recurrence (hazard ratio 1.73, 95% confidence interval 1.23-2.48; P = 0.002). The patients treated by high-volume operators were less likely to have major complications (1.4% vs. 7.8%; P = 0.001), and had a shorter procedural duration (139.9 ± 25.3 vs. 149.3 ± 27.1 min; P = 0.03). CONCLUSIONS: Operator proficiency may predict the outcome after AF ablation even in high-volume centres.
Sairaku et al. (Tue,) conducted a cohort in Paroxysmal atrial fibrillation (n=471). High-volume operator (≥50 cases/year) vs. Low-volume operator (<50 cases/year) was evaluated on Freedom from AF recurrence 1 year after the ablation (HR 1.73, 95% CI 1.23-2.48, p=0.002). AF ablation by high-volume operators (≥50 cases/year) was associated with greater freedom from AF recurrence at 1 year compared to low-volume operators (HR 1.73; 95% CI 1.23-2.48; P=0.002).