Expanding Ablation Capacity with Innovation

Annual pulmonary vein isolation volume increased from 26 cases in 2017 to 119 cases in 2025.

Pulsed field ablation, introduced in 2024, rapidly became the dominant modality (37 cases in 2024; 84 in 2025).

Mean procedure time decreased year-on-year from 300 minutes in 2017 to 129 minutes in 2025. The largest annual percent decrease was in 2024, the year PFA was introduced.

Patients undergoing ablation demonstrated an increasing burden of cardiometabolic risk factors over time.

Findings informed planning to support cardiometabolic optimisation of patients alongside ongoing expansion of the ablation service.

Atrial fibrillation is a major contributor to cardiovascular morbidity and healthcare utilisation. Catheter ablation, particularly pulmonary vein isolation, plays an established role in rhythm control and is increasingly supported by contemporary guidelines.

Pulsed field ablation is a novel non-thermal ablation modality using electroporation to selectively target myocardial tissue. Robust clinical trial data have demonstrated favourable safety and efficiency profiles compared with conventional thermal ablation technologies. Its adoption represents both a technological advance and a potential catalyst for adjacent service improvements.

In 2024, pulsed field ablation was implemented at the Royal Brisbane & Women's Hospital. Subsequently, a structured service evaluation was undertaken to quantify the downstream effects.

The key question was how its implementation altered throughput, efficiency and broader service delivery. An additional objective was to understand the prevailing risk factor burden within the ablation cohort. It is important to understand the modifiable contributors to progression of atrial fibrillation beyond the procedural intervention.

The reduction in procedure time following pulsed field ablation implementation created additional capacity within the ablation service. Shorter cases translated into increased throughput, enabling a substantial rise in annual procedural volume.

Evaluating the impacts of the technology early after implementation proved essential. Registry data provided timely insight into how procedural innovation was reshaping service dynamics.

The strength of this work is in its real-world scope. Multi-year registry data allowed comparison across different technological eras within the same institution, offering a pragmatic view of how innovation performs outside trial settings.

Limitations include the observational nature of the data. Efficiency gains may also reflect cumulative operator experience and workflow refinement alongside the technological change. Additionally, longer-term arrhythmia outcomes were beyond the scope of this evaluation.

A key finding was the rising cardiometabolic risk factor burden within the ablation population. As procedural capacity expands, attention must also turn to upstream drivers of atrial fibrillation disease progression and recurrence.

In response to these findings, a general practitioner-led risk factor optimisation clinic is being established as a follow-on initiative to ensure that service growth aligns with comprehensive care. This clinic aims to embed structured management of weight, hypertension, diabetes, sleep apnoea and lifestyle factors into the ablation pathway. This is consistent with current evidence demonstrating improved outcomes with structured risk factor modification.

We look forward to the ongoing evaluation of this flow on initiative. We expect this model may also be applicable to heart failure, coronary disease and structural heart pathways where modifiable risk factors drive outcomes.

Future work will examine long-term clinical outcomes, atrial fibrillation recurrence and repeat procedure rates and the impact of integrated optimisation strategies. There is opportunity for replication of similar service evaluations in other Queensland Health ablation centres introducing pulsed field ablation. Understanding the system impact of emerging technologies is essential for proactive future service planning.

This project illustrates how procedural innovation can act as a catalyst for service improvement, improving patient access while prompting a more integrated approach to atrial fibrillation care.

Reddy VY, et al. Pulsed field ablation for atrial fibrillation. N Engl J Med. 2023.

Wazni OM, et al. Pulsed field ablation versus thermal ablation for atrial fibrillation (ADVENT Trial). N Engl J Med. 2023.

Hindricks G, et al. 2024 ESC Guidelines for the management of atrial fibrillation. Eur Heart J. 2024.

Pathak RK, et al. Aggressive risk factor reduction study for atrial fibrillation and implications for ablation outcome (ARREST-AF). J Am Coll Cardiol. 2014.