Five-year trends in ablation workflows and outcomes: insights from the EP Device Registry

Background

Ablation workflows are frequently changing as new technologies and techniques are adopted. Here we examine trends in standard-of-care ablation workflows and outcomes across Europe and India since 2020.

Methods

Trends were analyzed across primary indications for treatment of AF, SVT, and ventricular arrhythmia (VA) from 3005 subjects enrolled in the EP Device Registry from 2020 to 2024.

Results

Overall, the demographics of the enrolled population remained similar from 2020 to 2024, with comparable age, proportion of female subjects, height, weight, body mass index, and ejection fraction. The average age was consistently highest for subjects with an indication of AF (64.9 ± 10.1 years in 2024) and the proportion of female subjects was highest in SVT cases (53.6% in 2024) and lowest in VA cases (28.3%).

Within each arrhythmia category, total procedure times did not change across the 5-year period. For AF, RF and fluoroscopy times decreased, but these times increased for VA and remained constant for SVT. Lesion types also changed over time, depending on indication for treatment—point-by-point lesions increased in AF cases and decreased in VA cases in 2024. Moderate conscious sedation use remained constant for AF cases but increased slightly for SVT cases (36.9% to 47.2%) and drastically for VA cases (16.7% to 52.9%).

For cases that used RF energy, power levels and per-lesion RF times also changed (Figure 1). In AF cases, an increase in maximum power on the anterior and posterior pulmonary veins was seen, though average per-lesion RF times remained similar across years. Non-pulmonary vein lesion parameters in the left atrium did not greatly change. For SVT cases, per-lesion RF times along the CTI line decreased (86.9 ± 125.4 s to 33.9 ± 18.9 s), but maximum power did not greatly vary. For non-CTI ablations in the right atrium, per-lesion RF times increased from 35.3 ± 6.7 s to 46.3 ± 41.9 s. For VA cases, per-lesion RF times generally decreased in the left ventricle (84.7 ± 38.1 s to 45.1 ± 45.2 s), with a slight increase in maximum power (41.8 ± 6.7 W to 45.2 ± 7.8 W).

Procedural outcomes and safety events (Figure 2) were similar between 2020 and 2024 for AF cases. For SVT cases, arrhythmia recurrence at 6 months post-procedure decreased over time, from 16.7% to 5.5%. For VA cases, acute procedural success increased (81.8% to 98.9%) and repeat ablations within 6 months of the procedure trended downwards (10.0% to 3.6%).

Conclusions

Over the last 5 years, the introduction of new technologies, such as contact force-sensing catheters, and adoption of techniques, such as high-power short-duration ablations, led to altered workflows. With time, safety rates remained constant, and several procedural outcomes improved. Monitoring these trends into the future will provide interesting insight as new technologies, including pulsed field ablation, are adopted and optimized over time.Figure 1.Ablation ParametersFigure 2.Ablation Outcomes