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May 17, 2026Journal of ArrhythmiaOpen Access

Interlesion Time as a Key Metric of Procedural Proficiency in Atrial Fibrillation Ablation: From Fellow to Attending

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Why the study?

Radiofrequency ablation requires precise catheter control and poses a steep learning curve, prompting a comparison of technical procedural parameters between attending and fellow electrophysiologists.

Does operator experience (attending vs. fellow) improve procedural metrics such as inter-lesion time during first-time AF ablation?

Population

194 patients undergoing first-time AF ablation

Comparison

Three attending vs five fellow electrophysiologists

Design

Observational study using cloud-based data analysis

Key result

Attending electrophysiologists achieved significantly shorter inter-lesion times during right pulmonary vein isolation compared to fellows (4.8 vs 9.6 seconds; p<0.001).

Authors

HMHitoshi MoriDKDaisuke KawanoMNMasataka Narita

Discussion

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Overview

Shorter ILT by attendings may guide fellow supervision in PVI; leaves open whether ILT optimization improves outcomes.

Key Points

  • This study aims to assess the impact of inter-lesion time on procedural proficiency in atrial fibrillation ablation between fellows and attending electrophysiologists.
  • Analyzed data from 194 patients undergoing first-time atrial fibrillation ablation.
  • Compared procedural metrics, including inter-lesion time, contact force, and catheter stability across attending and fellow electrophysiologists.
  • Data collected between April 2023 and September 2024.
  • Attending electrophysiologists achieved significantly shorter inter-lesion times in pulmonary vein isolation compared to fellows (right PV: 4.8 vs. 9.6 seconds, p < 0.001).
  • Left PV inter-lesion times were also shorter in attendings compared to fellows (6.7 vs. 12.7 seconds, p < 0.001).
  • Fellows showed smaller differences in inter-lesion times in non-PV regions, indicating early skill acquisition.

Study Design

Type

Observational (n=194)

Structured PICO

Does operator experience (attending vs. fellow) improve procedural metrics such as inter-lesion time during first-time AF ablation?

P
Population
194 patients undergoing first-time atrial fibrillation (AF) ablation
I
Intervention
Radiofrequency ablation performed by attending electrophysiologists (n=3)
C
Comparator
Radiofrequency ablation performed by fellow electrophysiologists (n=5)
O
Outcome
Procedural metrics, including inter-lesion time (ILT), contact force (CF), and catheter stability across six anatomical regionssurrogate

Main Result

Effect estimate: Hedges' g = -0.578

Absolute Event Rate: 4.8% vs 9.6%

p-value: p=<0.001

Inter-lesion time is a key metric reflecting procedural proficiency in radiofrequency AF ablation, with attending electrophysiologists achieving significantly shorter times than fellows.

Cite This Study

Mori et al. (2026) conducted an observational in Atrial fibrillation (n=194). Attending electrophysiologists vs. Fellow electrophysiologists was evaluated on Inter-lesion time (ILT) in right pulmonary vein (Hedges' g = -0.578, p=<0.001). Attending electrophysiologists achieved significantly shorter inter-lesion times during right pulmonary vein isolation compared to fellows (4.8 vs 9.6 seconds; p<0.001).

synapsesocial.com/papers/6a095b3f7880e6d24efe1043https://doi.org/10.1002/joa3.70360
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