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Updated: Mar 26, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Who is the operator, that is the question: a multicentre study of catheter ablation of atrial fibrillation
Akinori Sairaku1, Yukihiko Yoshida2, Yukiko Nakano3
1Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan rjrgw059@ybb.ne.jp.
Insights
High-volume atrial fibrillation (AF) ablation operators achieve better outcomes. Patients treated by experienced operators had higher success rates and fewer complications in high-volume centers.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Device Technology
Background:
- A global survey indicated higher success rates for atrial fibrillation (AF) ablation in high-volume centers compared to low-volume ones.
- This study investigates the impact of individual operator volume on AF ablation outcomes within high-volume centers.
Purpose of the Study:
- To determine if the procedural volume of each operator is associated with the success of AF ablation in high-volume centers.
- To analyze the relationship between operator experience and patient outcomes, including recurrence, complications, and procedure duration.
Main Methods:
- A study of 471 patients with paroxysmal AF undergoing their first pulmonary vein (PV) isolation in three high-volume centers (>100 AF ablations/year).
- Operators were categorized as high-volume (≥50 cases/year) or low-volume (<50 cases/year) based on ACC/AHA/ACP criteria.
- Endpoints included freedom from AF recurrence at 1 year, major complications, and procedural duration.
Main Results:
- Complete PV isolation was achieved in 99.1% of patients.
- Freedom from AF recurrence was significantly higher for patients treated by high-volume operators (76.4%) versus low-volume operators (62.8%; P=0.001).
- High-volume operators were associated with fewer major complications (1.4% vs. 7.8%; P=0.001) and shorter procedural times (139.9 min vs. 149.3 min; P=0.03).
Conclusions:
- Operator proficiency is a significant predictor of AF ablation outcomes, even within high-volume centers.
- Increased operator experience correlates with improved patient outcomes and procedural efficiency.
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.
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