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RF-based ablation uses radiofrequency energy to inactivate the heart tissue responsible for producing irregular electrical signals. Though RF-based ablation's safety and efficacy have been previously demonstrated in randomized, controlled clinical trials, the technique is ever evolving, and little is known about the effectiveness and safety of the technique outside of clinical trials. The study used data from the REAL-AF registry, a multi-center registry that Zei co-founded in 2019 to evaluate long-term outcomes and clinical management in patients treated for AF. The registry consists of over 50 centers that regularly perform a high volume of RF-ablation procedures and who conform to contemporary best-practice techniques-;including a focus on isolating the pulmonary vein, reducing or eliminating the use of fluoroscopy during the procedure, and using a shorter but higher blast of radiofrequency to reduce procedural time. "We studied experienced operators and centers to try to ensure that we were studying the best techniques that are already being used," Zei said. "Our motivation is to learn the best approaches for RF-based ablation and adjust and improve those approaches so that our outcomes get even better." Zei's team reports that procedures in the REAL-AF registry are more efficient, safe, and effective compared to data from randomized clinical trials. At one-year follow-up, freedom from all-atrial arrhythmia and AF were 81.6 percent and 85.7 percent, respectively. Moreover, 93.2 percent of patients reported no arrhythmia symptoms during the follow-up period. Average procedure time was also significantly shorter, which improves patient safety by reducing time under anesthesia and means that hospitals and operators can perform more of these high-demand procedures. Going forward, the researchers plan to continue to refine RF-ablation procedure for both paroxysmal AF, the focus of this study, and persistent AF. "It's an ongoing endeavor," said Zei. "An important next step will be to apply similar strategies to try to understand how this procedure can be improved for patients with the persistent type of AF, which is more difficult to treat than paroxysmal AF." In the future, Zei says that the registry model used in this study could be easily adapted to optimize other medical procedures in electrophysiology and beyond. "As well as being a study, the registry is a learning health network. We're not only evaluating the best approach for RF-based ablation; we're also learning from each other," Zei said. "The goal is to disseminate best practices across every operator and center." Source: Mass General Brigham Journal reference: