Offsetting costs of new ablation technologies with increased procedural efficiency and volume

New technologies may affect efficacy, safety, efficiency, or cost of pulmonary vein isolation (PVI) ablation for atrial fibrillation (AF).

This study aimed to compare efficiencies and costs of radiofrequency (RF), over-the-wire (OTW) pulsed field ablation (PFA), and lattice tip dual energy (DE) ablation (RF/PFA) platforms in a real-world United States (US) clinical setting.

Patients aged ≥18 years undergoing PVI in 3 US hospitals between January 1, 2024, and November 14, 2025, were included. Univariable and multivariable linear regression analyses were performed to compare procedure time and costs across procedure platforms.

Among 3173 PVI procedures, 2986 met inclusion and exclusion criteria. The unadjusted procedure time (minutes) was shorter with lattice DE 118 (interquartile range [IQR] 101-138) compared with RF 137 (117-163) or OTW PFA 135 (IQR 112-163), (P < .001 for both comparisons). There was no difference in median procedure time for OTW PFA compared with RF (P = .12). In multivariable analysis, lattice DE (-31 (IQR -33 to -28) minutes/case) and OTW PFA (-9 [IQR -12 to -5] minutes/case) were associated with a reduction in median procedure time compared with RF (P < .001 for both comparisons). OTW PFA ($3600 (IQR $3413-$3884) per case) and lattice DE ($4469 (IQR $4327-$4611) per case) were independently associated with increased cost per case compared with RF, (P < .001 for comparison.) CONCLUSION: Use of a lattice DE is associated with AF ablation efficiency improvements sufficient to perform additional procedure volume that partially offsets increased technology costs. OTW PFA was associated with increased cost and insufficient efficiency improvements to allow for increased procedure volume.