Insights Into Early Adoption and Physician Learning Curve of Pulsed Field Ablation in the United States

Amin Al-Ahmad; Daniela Hincapie; Paul C Zei; Andrea Natale; David Kessler; Joe Gallinghouse; Weeranun Bode; Jose Osorio; Jonathan W Dukes; Rob Eckart; Anish Amin; Yoel Vivas; Luis Mora; Amit Thosani; Joshua Silverstein; Anil Rajendra; Gustavo Morales; Michael Manogue; Joseph Donnelly; Frank Cuoco; Darren Sidney; Robert Brewer; Jason Meyers; Mark D Metzl; Guru Mohanty; Michael Rehorn; Paari Dominic; John D Day; Nischala Nannapaneni; John Costello; DISRUPT-AF Investigators

doi:10.1161/CIRCEP.125.013982

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Insights Into Early Adoption and Physician Learning Curve of Pulsed Field Ablation in the United States

Journal article

Peer reviewed

Insights Into Early Adoption and Physician Learning Curve of Pulsed Field Ablation in the United States

Amin Al-Ahmad, Daniela Hincapie, Paul C Zei, Andrea Natale, David Kessler, Joe Gallinghouse, Weeranun Bode, Jose Osorio, Jonathan W Dukes, Rob Eckart, …

Circulation. Arrhythmia and electrophysiology, Vol.18(11), e013982

11/2025

DOI: 10.1161/CIRCEP.125.013982

PMID: 41133296

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Abstract

BACKGROUND: Pulsed field ablation (PFA) has been available in Europe since 2021. In the United States, PFA became commercially available in 2024, and practice patterns are expected to differ from those in Europe. The objective of this study was to describe acute procedural efficiency and safety outcomes, clinical workflow patterns, and the physician learning curve associated with PFA for paroxysmal and nonparoxysmal atrial fibrillation in the first US real-world registry. METHODS: DISRUPT-AF is a prospective, multicenter registry capturing patient-level data on first-time PFA procedures for paroxysmal atrial fibrillation and nonparoxysmal atrial fibrillation using the pentaspline catheter. Patient baseline characteristics and acute procedural efficiency and safety outcomes were collected. Physicians’ learning curve analyses were assessed by categorizing experience levels as 1 to 3, 4 to 10, and >11 procedures. RESULTS: A total of 1076 patients were included; 80.9% of the cases involved ablation beyond the pulmonary veins. Most procedures were performed under general anesthesia (90.2%) using electroanatomic mapping (94.8%). The mean procedural time was 66.64±28.36 minutes. The median fluoroscopy time was 6.17 (0–11.6) minutes, with 25.3% of cases performed using a zero-fluoroscopy approach and 31% utilizing a low-fluoroscopy approach (<2 minutes). The overall procedure-related complication rate was low (1.7%), driven primarily by vascular access complications requiring intervention or transfusion. Procedural efficiency improved with operator experience, evidenced by a reduction in both procedural and fluoroscopy times. CONCLUSIONS: Initial US experience with the pentaspline PFA catheter demonstrated key differences from previously reported European workflows, including higher use of general anesthesia and electroanatomic mapping. Physician learning curve analysis indicated rapid adoption, with improvements in procedural efficiency and consistent safety with operator experience.

Heart Failure

myocytes, cardiac

atrial fibrillation

catheter ablation

pulmonary veins

Details

Title: Subtitle: Insights Into Early Adoption and Physician Learning Curve of Pulsed Field Ablation in the United States
Creators: Amin Al-Ahmad - Texas Cardiac Arrhythmia
Daniela Hincapie - Brigham and Women's Hospital
Paul C Zei - Brigham and Women's Hospital
Andrea Natale - Texas Cardiac Arrhythmia
David Kessler - Texas Cardiac Arrhythmia
Joe Gallinghouse - Texas Cardiac Arrhythmia
Weeranun Bode - Texas Cardiac Arrhythmia
Jose Osorio - HCA Florida, Miami (J.O.)
Jonathan W Dukes - Memorial Health System
Rob Eckart - Sarasota Memorial Hospital
Anish Amin - OhioHealth
Yoel Vivas - The Arrhythmia Institute
Luis Mora - Arrhythmia Center of South Florida (Y.V., L.M.)
Amit Thosani - Allegheny Health Network
Joshua Silverstein - Allegheny Health Network
Anil Rajendra - The Arrhythmia Institute
Gustavo Morales - The Arrhythmia Institute
Michael Manogue - Mission Hospital
Joseph Donnelly - Mission Hospital
Frank Cuoco - Charleston Community Unit School District 1
Darren Sidney - Charleston Community Unit School District 1
Robert Brewer - Mercy Medical Center
Jason Meyers - Mercy Medical Center
Mark D Metzl - Endeavor Health, Glenview, IL (M.D.M.)
Guru Mohanty - Chippenham Hospital, Richmond, VA (G. Mohanty, M.R.)
Michael Rehorn - Chippenham Hospital, Richmond, VA (G. Mohanty, M.R.)
Paari Dominic - University of Iowa Hospitals and Clinics
John D Day - St. Mark's Hospital
Nischala Nannapaneni - St. Mark's Hospital
John Costello - Cardiovascular Associates of Delaware Valley, Haddon Heights, NJ (J.C.)
DISRUPT-AF Investigators
Resource Type: Journal article
Publication Details: Circulation. Arrhythmia and electrophysiology, Vol.18(11), e013982
DOI: 10.1161/CIRCEP.125.013982
PMID: 41133296
NLM abbreviation: Circ Arrhythm Electrophysiol
ISSN: 1941-3149
eISSN: 1941-3084
Publisher: LIPPINCOTT WILLIAMS & WILKINS
Grant note: DISRUPT-AF registry from Boston Scientific
The DISRUPT-AF registry is funded through a research agreement from Boston Scientific.
Language: English
Electronic publication date: 10/24/2025
Date published: 11/2025
Academic Unit: Cardiovascular Medicine; Internal Medicine
Record Identifier: 9985019034602771

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