The Ongoing Influence of Staff Training on the Performance of Radiofrequency Catheter Ablation

Abstract

The aim of this study was to assess whether the performance of RF catheter ablations continues to improve by further staff training once an initial success rate of > 90% has been achieved. Two hundred and ninety-five procedures of SVT catheter ablation using RF energy were studied. Atrial tachycardia and atrial flutter substrate ablations were not included. The procedures were performed during a 4-year period by the same physician and nurse, who had previous training in these procedures. The 4-year period was subdivided into four consecutive 1-year periods in which 69, 72, 68, and 86 procedures were performed. The outcome, recurrence rate, and duration of the curative procedure were compared among the four periods. There was no significant difference in the initial success rate among the four periods. The recurrence rate decreased from 21.74% to 13.95% (P < 0.05). The duration of the curative procedure decreased from 93.7 +/- 78.4 minutes to 39.1 +/- 32.2 minutes (P < 0.001), and the fluoroscopic time decreased from 25.5 +/- 22.3 minutes to 11.3 +/- 8.2 minutes (P < 0.001). These results were similar when accessory pathway and selective AV nodal pathways ablations were separately evaluated. Following the initial staff training, during which the expected 80%-90% success rate is achieved, additional training will reduce the recurrence rate and the duration of the procedures at a similar level of success.

American College of Cardiology/American Heart Association 2006 Update of the Clinical Competence Statement on Invasive ElectrophysiologyStudies,CatheterAblation,andCardioversion

“…Several studies have shown that success rates improve and fluoroscopy times decrease with experience (67)(68)(69)(70). Although there are many determinants of arrhythmia recurrences, recurrence rates drop with operator experience (71). Each of these studies involved operators with extensive prior experience in electrophysiology, and it would be expected that the number of procedures required for a new trainee to gain expertise in ablation would be higher than that for an experienced electrophysiologist.…”

American College of Cardiology/American Heart Association Clinical Competence Statement on Invasive Electrophysiology Studies, Catheter Ablation, and Cardioversion

“…[55][56][57][58] Although there are many determinants of arrhythmia recurrences, recurrence rates drop with operator experience. 59 Each of these studies involved operators with extensive prior experience in electrophysiology, and it would be expected that the number of procedures required for a new trainee to gain expertise in ablation would be higher than that for an experienced electrophysiologist. The risks of ablation similarly have been reported by experienced operators.…”