Atrial Fibrillation Ablation Technology Adoption and Procedural Metrics: An 11-Year Longitudinal Service Evaluation at a UK Tertiary Centre

Background: Contemporary AF ablation practice has changed rapidly with the introduction of newer energy-delivery platforms. How these changes translate into longitudinal patterns of technology use and procedural characteristics within routine electrophysiology services is less well described. Methods: We performed a retrospective, procedure-level longitudinal service evaluation of AF ablations performed between April 2014 and June 2025 at a United Kingdom (UK) tertiary center. Index and repeat procedures were included. We describe annual technology use and observed skin-to-skin procedure time, fluoroscopy time, and dose-area product (DAP). These are operational measures, not surrogate clinical endpoints. We undertook no adjusted comparative analysis because technology choice was coupled with calendar era and relevant clinical and operator-level covariates were incomplete. Results: The analysis included 2862 procedures, comprising 1878 (66%) radiofrequency ablation (RFA), 735 (26%) cryoballoon, and 249 (9%) pulsed field ablation (PFA). RFA remained the predominant approach until 2020, cryoballoon use peaked in 2018 (n = 138), and PFA increased from 56 procedures in 2023 to 98 in 2024 and 95 in the first half of 2025. The median skin-to-skin time changed from 205 min in 2014 to 104 min in 2025. Observed median fluoroscopy time changed from 32 to 13 min, and median DAP from 3405 to 782 Gy.cm2. Conclusions: Over 11 years, the centre experienced a marked change in AF ablation practice, characterised by the progressive adoption of newer technologies, alongside lower recorded procedure durations and radiation exposure. These observations describe service-level temporal trends and should not be interpreted as evidence that any individual ablation modality caused the observed changes or improved clinical outcomes.