Related Experiment Video
Updated: May 19, 2026
Reduced Procedure Time and Variability with Active Esophageal Cooling During Radiofrequency Ablation for Atrial Fibrillation
Published on: August 25, 2022
Interlesion Time as a Key Metric of Procedural Proficiency in Atrial Fibrillation Ablation: From Fellow to Attending
Hitoshi Mori1, Daisuke Kawano1, Masataka Narita1
1Department of Cardiology Saitama Medical University, International Medical Center Hidaka Japan.
Introduction:
Pulmonary vein isolation (PVI) is a cornerstone of atrial fibrillation (AF) ablation. Unlike balloon-based or pulsed field ablation, radiofrequency ablation requires precise catheter control and poses a steeper learning curve. This study aimed to compare technical parameters between attending and fellow electrophysiologists (EPs) using data extracted via cloud-based analysis.
Methods:
A total of 194 patients undergoing first-time AF ablation between April 2023 and September 2024 were analyzed. Procedural metrics, including contact force (CF), inter-lesion time (ILT), and catheter stability, were compared across six anatomical regions between three attending and five fellow EPs.
Results:
Attending EPs achieved significantly shorter ILTs in PVI with moderate-to-large effect sizes (Attending vs. Fellows, sec; right PV, 4.8 [4.3-8.4] vs. 9.6 [5.5-15.6], p < 0.001, Hedges' g = -0.578; left PV, 6.7 [4.5-12.8] vs. 12.7 [6.9-21.7], p < 0.001, Hedges' g = -0.473), while CF and catheter stability showed smaller differences. In non-PV regions such as the CTI and roof line, ILT differences were smaller, suggesting early skill acquisition in linear ablation areas by fellows.
Discussion:
ILT best reflected operator experience, with shorter ILTs likely contributing to improved lesion continuity and procedural proficiency. Fellows demonstrated comparable CF and catheter stability, potentially aided by steerable sheath use. Mastery of anatomical navigation may be key to advancing proficiency.
Conclusion:
Shorter ILTs by attending EPs reflect greater procedural proficiency. Emphasizing anatomical understanding and deliberate catheter manipulation during training may enhance skill development and improve clinical outcomes.
