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

Amin Al-Ahmad¹, Daniela Hincapie-Tabares², Paul C Zei^{2

3}, Andrea Natale^{1

4

5}, David Kessler¹, Joe Gallinghouse¹, Weeranun Bode¹, Jose Osorio⁶, Jonathan W Dukes⁷, Robert Eckart⁸, Anish Amin⁹, Yoel Vivas¹⁰, Luis Mora¹⁰, Amit Thosani¹¹, Joshua Silverstein¹¹, Anil Rajendra¹², Gustavo Morales¹², Michael Manogue¹³, Joseph Donnelly¹³, Frank Cuoco¹⁴, Darren Sidney¹⁴, Robert Brewer¹⁵, Jason Meyers¹⁵, Mark D Metzl¹⁶, Guru Mohanty¹⁷, Michael Rehorn¹⁷, Paari Dominic¹⁸, John D Day¹⁹, Nischala Nannapaneni¹⁹, John Costello²⁰; DISRUPT-AF Investigators

Collaborators, Affiliations

Collaborators

DISRUPT-AF Investigators:
Francis Benn, Jaret Tyler, Eugene Fu, David Nemer, Nagesh Chopra, Ankur Shah, Auroa Badin, Sreedhar Billakanty, Charles Joyner, Saumil Shah, Harsimran Saini, Tharian Cherian, George Shaw, William Belden, Mati Friehling, Charles Miller, William Sauer, Sunil Kapur, Bruce Koplan, Nathaniel Steiger, Mark Freher, David Burkhardt, Khaled Awad, Jason Zagrodzky, David Tschopp, Paul Coffeen, John Allison, Mohamed Bassiouny, Rodney Horton, Gerald Gallinghouse, Amr Barakat, Anthony Magnano, Saumil Oza, Likhitesh Jaikumar, Robert Eckart, George Mark, Pitayadet Jumrussirikul, Mohit Chawla, Troy Hounshell, Dwayne Campbell, Denise Sorrentino

Affiliations

¹ Texas Cardiac Arrhythmia Research Foundation, Austin (A.A.-A., A.N., D.K., J.G., W.B.).
² Cardiac Arrythmia Service, Division of Cardiovasculr Medicine, Brigham and Women's Hospital, Boston, MA (D.H.-T., P.C.Z.).
³ Heart Rhythm and Clinical Research Solutions, LLC, Birmingham AL (P.C.Z.).
⁴ Division of Cardiology, Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy (A.N.).
⁵ Case Western University School of Medicine, Cleveland, OH (A.N.).
⁶ HCA Florida, Miami (J.O.).
⁷ Community Memorial Health Systems, Ventura, CA (J.W.D.).
⁸ Sarasota Memorial Hospital, FL (R.E.).
⁹ OhioHealth Research Institute, Columbus (A.A.).
¹⁰ Arrhythmia Center of South Florida, Boca Raton, FL (Y.V., L.M.).
¹¹ Allegheny Health Network, Pittsburgh, PA (A.T., J.S.).
¹² Arrhythmia Institute at Grandview, Birmingham, AL (A.R., G. Morales).
¹³ Mission Hospital, Asheville, NC (M.M., J.D.).
¹⁴ Trident Medical Center, Charleston, SC (F.C., D.S.).
¹⁵ Mercy One Iowa Heart Center, West Des Moines (R.B., J.M.).
¹⁶ Endeavor Health, Glenview, IL (M.D.M.).
¹⁷ Chippenham Hospital, Richmond, VA (G. Mohanty, M.R.).
¹⁸ University of Iowa Hospitals and Clinics (P.D.).
¹⁹ St. Mark's Hospital, Salt Lake City, UT (J.D.D., N.N.).
²⁰ Cardiovascular Associates of Delaware Valley, Haddon Heights, NJ (J.C.).

PMID: 41133296
DOI: 10.1161/CIRCEP.125.013982

Free article

Multicenter Study

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

Amin Al-Ahmad et al. Circ Arrhythm Electrophysiol. 2025 Nov.

Free article

. 2025 Nov;18(11):e013982.

doi: 10.1161/CIRCEP.125.013982. Epub 2025 Oct 24.

Authors

Collaborators

DISRUPT-AF Investigators:
Francis Benn, Jaret Tyler, Eugene Fu, David Nemer, Nagesh Chopra, Ankur Shah, Auroa Badin, Sreedhar Billakanty, Charles Joyner, Saumil Shah, Harsimran Saini, Tharian Cherian, George Shaw, William Belden, Mati Friehling, Charles Miller, William Sauer, Sunil Kapur, Bruce Koplan, Nathaniel Steiger, Mark Freher, David Burkhardt, Khaled Awad, Jason Zagrodzky, David Tschopp, Paul Coffeen, John Allison, Mohamed Bassiouny, Rodney Horton, Gerald Gallinghouse, Amr Barakat, Anthony Magnano, Saumil Oza, Likhitesh Jaikumar, Robert Eckart, George Mark, Pitayadet Jumrussirikul, Mohit Chawla, Troy Hounshell, Dwayne Campbell, Denise Sorrentino

Affiliations

¹ Texas Cardiac Arrhythmia Research Foundation, Austin (A.A.-A., A.N., D.K., J.G., W.B.).
² Cardiac Arrythmia Service, Division of Cardiovasculr Medicine, Brigham and Women's Hospital, Boston, MA (D.H.-T., P.C.Z.).
³ Heart Rhythm and Clinical Research Solutions, LLC, Birmingham AL (P.C.Z.).
⁴ Division of Cardiology, Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy (A.N.).
⁵ Case Western University School of Medicine, Cleveland, OH (A.N.).
⁶ HCA Florida, Miami (J.O.).
⁷ Community Memorial Health Systems, Ventura, CA (J.W.D.).
⁸ Sarasota Memorial Hospital, FL (R.E.).
⁹ OhioHealth Research Institute, Columbus (A.A.).
¹⁰ Arrhythmia Center of South Florida, Boca Raton, FL (Y.V., L.M.).
¹¹ Allegheny Health Network, Pittsburgh, PA (A.T., J.S.).
¹² Arrhythmia Institute at Grandview, Birmingham, AL (A.R., G. Morales).
¹³ Mission Hospital, Asheville, NC (M.M., J.D.).
¹⁴ Trident Medical Center, Charleston, SC (F.C., D.S.).
¹⁵ Mercy One Iowa Heart Center, West Des Moines (R.B., J.M.).
¹⁶ Endeavor Health, Glenview, IL (M.D.M.).
¹⁷ Chippenham Hospital, Richmond, VA (G. Mohanty, M.R.).
¹⁸ University of Iowa Hospitals and Clinics (P.D.).
¹⁹ St. Mark's Hospital, Salt Lake City, UT (J.D.D., N.N.).
²⁰ Cardiovascular Associates of Delaware Valley, Haddon Heights, NJ (J.C.).

PMID: 41133296
DOI: 10.1161/CIRCEP.125.013982

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 (A Registry Based Collaborative to Measure Efficiency, Effectiveness, and Safety of Farapulse PFA Technology for 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.

Keywords: atrial fibrillation; catheter ablation; heart failure; myocytes, cardiac; pulmonary veins.

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Conflict of interest statement

Dr Al-Ahmad reports consulting with Boston Scientific. Dr Natale reports consulting for Abbott, Biosense Webster, Biotronik, Boston Scientific, iRhythm, Field Medical, Haemonetics, Medtronic, and Pulse Bioselect. Dr Osorio reports consulting with Boston Scientific. Dr Dukes reports consulting and research from JNJ MedTech, Boston Scientific, and Medtronic. Dr Silverstein reports honoraria and consulting from JNJ MedTech and Medtronic, and honoraria from Impulse Dynamics. Dr Cuoco, Rehorn, and Dominic report consulting for Boston Scientific. The other authors report no conflicts.

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

Collaborators

Affiliations

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

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical