Electrophysiology lab efficiency simulation: a comparison between novel dual-energy lattice-tip and conventional contact-force sensing radiofrequency ablation systems.

Abstract

Objectives: Increasing atrial fibrillation (AF) disease-related healthcare burden, coupled with positive evidence on catheter ablation for AF, has led to pressure on hospital procedure efficiency. Medtronic's Sphere-9 system (a novel lattice-tip dual-energy pulsed field and radiofrequency [RF] ablation catheter) demonstrated non-inferiority in effectiveness and superiority in procedural times compared with a contact-force sensing RF catheter (ThermoCool SmartTouch SF [STSF]). This analysis evaluated the impact of procedural efficiencies on electrophysiology (EP) lab utilization.

Methods: A discrete event simulation model evaluated EP lab efficiency using procedure times from the SPHERE Per-AF trial for pulmonary vein isolation-only cases and those with additional ablation lesion sets. Lab day ran from 7 am to 7 pm with 1 hour needed to perform an additional non-ablation EP case, and same-day discharge was allowed for cases ending by 5 pm.

Results: Analysis included 211 patients in the Sphere-9 arm and 207 in the STSF arm. Procedure times were 100.8 ± 31 minutes for Sphere-9 and 125.9 ± 49 for STSF. Sphere-9 resulted in more than a 10-fold reduction in cumulative overtime hours (41 hours for Sphere-9 vs 424 for STSF). Overtime occurred on 7% of lab days with Sphere-9 and 36% with STSF. Additionally, 73% of Sphere-9 lab days allowed for 1 additional non-ablation EP case compared with 40% of STSF lab days. Finally, 38% of Sphere-9 lab days allowed for same-day discharge for the third case compared with 17% of STSF lab days.

Conclusions: In patients with persistent AF, the Sphere-9 system was more efficient and predictable compared with STSF, leading to significant improvements in EP lab efficiency.