title: Effects of operator experience on the outcome and duration of pulmonary vein isolation procedures for atrial fibrillation.
abstract: Segmental, ostial ablation to isolate the pulmonary veins has been shown to be effective for the treatment of atrial fibrillation (AF). The purpose of this study was to determine the effects of operator experience on the outcome and duration of pulmonary vein isolation procedures for AF. One hundred three consecutive patients with AF underwent segmental, ostial ablation to isolate pulmonary veins. The effect of operator experience on the outcome and duration of the procedure was measured. The mean procedure duration was 232 +/- 70 minutes (range 50 to 460). There was an indirect linear relation between the total procedure time and the number of procedures performed (r = -0.68; p <0.001), and between the total fluoroscopic time and the number of procedures performed (r = -0.71; p <0.001). The percentage of patients in whom complete isolation of the pulmonary veins was achieved and the total duration of radiofrequency energy delivered during the procedures remained stable as operator experience increased. Operator experience was not an independent predictor of recurrent AF. The primary effect of operator experience on pulmonary vein isolation procedures for AF was a marked reduction in the duration of the procedure and fluoroscopic time. Long procedure durations and large amounts of radiation exposure may currently limit the widespread application of this therapy. The results of this study suggest that after >75 cases, segmental ablation to isolate the pulmonary veins using fluoroscopy and conventional radiofrequency ablation usually is feasible in <3 hours.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA. bknight@medicine.bsd.uchicago.edu
authors.forename: Bradley P
authors.initials: BP
authors.lastname: Knight
authors.forename: Hakan
authors.initials: H
authors.lastname: Oral
authors.forename: Aman
authors.initials: A
authors.lastname: Chugh
authors.forename: Christoph
authors.initials: C
authors.lastname: Scharf
authors.forename: Steve W K
authors.initials: SW
authors.lastname: Lai
authors.forename: Frank
authors.initials: F
authors.lastname: Pelosi
authors.forename: S Adam
authors.initials: SA
authors.lastname: Strickberger
authors.forename: Fred
authors.initials: F
authors.lastname: Morady
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D002983:Clinical Competence; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors