As in previous years, AF was the most commonly treated ablation target and even exhibited a marked increase in the number of procedures (13 395 procedures in 2024 vs 9942 in 2023, a 35% increase). In total, 83% of centers conducted AF ablation, with a median of 91 procedures (P25-75, 38-192). Specifically, 57% of patients had paroxysmal AF, 38% had persistent AF, and 5% had long-standing persistent AF. These percentages are similar to those of previous years. The acute success rate was 95%.

The predominant ablation strategy was pulmonary vein isolation (12 236 procedures; 91%), followed by posterior wall isolation (10.7%), left atrial linear ablation (6.3%), pulmonary vein antrum ablation (5.25%), vein of Marshall ethanol infusion (1.8%), ablation of fibrotic areas (1.5%), superior vena cava isolation (0.7%), complex fractionated electrogram ablation (0.2%), and left atrial appendage isolation (0.2%). In 163 procedures, an additional approach was used.

Single-shot techniques were the most commonly used, comprising 55.2% of procedures. In addition, 33.7% of procedures were performed using cryoablation (39.4% in 2023) and 21.5% were performed using pulse-field ablation (PFA) (10.3% in 2023). The point-by-point ablation technique was used in 44.8% of procedures, generally with an irrigated-tip catheter with contact forcesensing technology (figure 6).

Figure 6.

Changes over time in ablation techniques for atrial fibrillation (AF) via point-by-point and single-shot ablation from 2015 to 2024.

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Mapping systems were used in 47.5% of procedures and 5.6% were fluoroscopy-free. As auxiliary instruments, steerable sheaths were used in 4885 procedures (a 22% increase vs 2023) and intracardiac echocardiography in 1509. A total of 5671 procedures were performed under general anesthesia (4511 in 2023) and 5544 with deep sedation. Finally, 1747 procedures (13%) were performed on an outpatient basis.

The incidence of complications was 2.4% (2.5% in 2023) (table 3). Two deaths were associated with the procedure: 1 from atrioesophageal fistula and 1 after cardiac surgery due to perforation.

In total, 6084 CTI procedures were recorded, which represents a 20% increase vs 2023 and once again meant that CTI was the second most commonly treated ablation target. A success rate of 98.6% was achieved, with a complication rate similar to that of 2023 (0.5% in both years) (table 3). The most frequently used catheters were irrigated-tip catheters with contact forcesensing technology (52% vs 41% in 2023), followed by standard irrigated catheters (32%). Nonirrigated catheters were used in 16% of procedures. The number of procedures performed with a mapping system increased (58% vs 52% in 2023), as well as those performed without fluoroscopy (30% vs 26% in 2023). Finally, 33% of procedures were performed on an outpatient basis.

AVNRT ablation was once again the third most commonly treated ablation target, after AF and CTI. Although the absolute number of procedures increased (4908 procedures, a 16% increase vs 2023), the relative percentage has tended to decrease in recent years (15%). The success rate was 97.9%, while the complication rate was 0.4% (table 3). The most frequently used energy source was radiofrequency, with just 3.7% of procedures performed using cryoablation. The use of mapping systems was maintained at 50%, and 40% of the procedures were fluoroscopy-free. Overall, 39% of AVNRT ablations were performed as outpatient procedures.

APs remained the fourth most commonly treated ablation target, with an 8.6% increase in procedures vs 2023 (2177 vs 2005 in 2023), representing 7% of all ablations performed. The success rate was 93.3%, while the complication rate was 0.9% (table 3). Left free wall pathways were the most frequent location (51.3%), followed by inferoseptal pathways (26.8%), para-Hisian/anteroseptal pathways (11.3%), and right free wall pathways (10.7%). Transseptal access was used more frequently than retroaortic access for the ablation of left pathways (63.9% vs 32.9%), and epicardial/coronary sinus access was required in just 3.2% of procedures. Mapping systems were used in 58.5% of procedures and 20% were fluoroscopy-free. Finally, 26% of these procedures were performed on an outpatient basis.

A total of 1400 AVN ablations were performed in 2024, 137 more than in 2023 (an 11% increase). The success rate was 98%, while the complication rate was 0.3%; all complications were vascular in nature.

The most frequently used catheters were 4-mm radiofrequency catheters (41%), followed by standard irrigated catheters (27%) and 8-mm catheters (23%). There were slight increases in procedures performed using a mapping system (7% vs 4.2% in 2023) and without fluoroscopy (5% vs 2.7%).

In 2024, 1166 MAT ablation procedures were reported, 206 more than in 2023. The most common location was the left atrium. Overall, 107 patients had congenital heart disease, 114 had undergone atriotomy, and 646 had undergone AF ablation. In 44 cases, selective embolization of the vein of Marshall was conducted, representing a marked increase vs the 18 such procedures recorded in 2023.

Mapping systems were used in 96% of procedures and 8% were fluoroscopy-free. The acute success rate was 89%, similar to previous years. Irrigated-tip catheters with contact forcesensing technology were used in 90% of procedures and PFA was applied in 54 (5 in 2023). In 2024, general anesthesia was used in 577 procedures, while deep sedation was used in 372. The complication rate was 1.5% (table 3). Two deaths were reported: 1 associated with sedation and 1 sudden death in the first 24hours after the intervention. Finally, 12.4% of procedures were performed on an outpatient basis.

Overall, 739 FAT ablations were reported (a 15% increase vs 2023). Most were conducted in the right atrium (71%). The success rate was 91%, similar to that of previous years.

Irrigated-tip catheters with contact forcesensing technology were the most commonly used catheters (70%); 10 procedures were performed with cryoablation and 8 with PFA. Six complications were recorded (table 3). Mapping systems were used in 78% of procedures and 22.6% were fluoroscopy-free. Finally, 28.6% of the procedures were performed on an outpatient basis.

In total, 1362 IVT procedures were performed (a 24% increase vs 2023). However, the proportion relative to the total in the registry remained unchanged at 4%. Increases were found in the number of centers conducting IVT ablation, from 85 to 93, and in the median number of cases per center (P25-75, 5-18). The most frequent location was the right ventricular outflow tract (44.4%), followed by the left outflow tract (33.2%). Less common sites were the papillary muscles (6.4%), fascicles of the conduction system (5.2%), the mitral annulus (4.5%), the moderator band (1.5%), the tricuspid annulus (1.3%), and the para-Hisian region (0.7%). The overall effectiveness was 91.8%. The most frequently used access routes were right ventricular endocardial (43.7%), retroaortic (38.9%), and transseptal (12.7%). Less frequently used access routes were epicardial (2.1%) and combined endocardial/epicardial (2.7%). Radiofrequency was the standard energy source, and irrigated-tip catheters with contact forcesensing technology predominated (79.2%). Radioablation was used in 4.5% of procedures and PFA use was rare (2 cases). Other ablation modalities were also uncommon (cryoablation, 5 cases; ethanol ablation, 3 cases). The use of mapping systems predominated (96% of procedures) and 19% were fluoroscopy-free. Seven complications were recorded (0.5%) (table 3). No deaths were reported. General anesthesia was used in 9.6% of procedures, while deep sedation was used in 16.7% and circulatory support in 1 procedure. Finally, 20.5% of the patients were managed as outpatients.

Despite the increase in centers (from 70 to 79; a 13% increase), the number of procedures (n = 623) and relative proportion (2%) were stable. The median number of procedures was 4 (P25-75, 1-8). Mapping systems predominated (97% of procedures) and 3% were fluoroscopy-free. The acute success rate was once again 85%. An exclusively ablation target-based ablation strategy accounted for 50% of procedures, whereas a combined strategy, guided by both ablation target and tachycardia induction, was used in 41%. Ablation guided solely by tachycardia induction was used in 9%. Irrigated-tip catheters with contact forcesensing technology were the most commonly used catheters (82%). There was a slight increase in stereotactic radioablation (6.1%), as well as the first procedures performed using dual-energy catheters (radiofrequency and PFA), although they remained rare (just 2 cases). Steerable sheaths were used in 63% of procedures. The most frequently used access route was transseptal (58%), followed by retroaortic (32%), combined endocardial/epicardial (6.5%), and exclusively epicardial (1.6%). General anesthesia was used in 61% of procedures and deep sedation in 18%. Just 2.7% were outpatient procedures. Mechanical hemodynamic support was used in 6.6% of procedures. The complication rate was 6.7% (table 3). Six deaths were reported: 2 due to cardiogenic shock, 2 due to cardiac perforation, 1 due to electromechanical dissociation, and 1 due to acute myocardial infarction.

This ablation target was treated in more centers than in 2023 (68 vs 59, a 15% increase). Although there was a slight increase in the number of procedures (367, an 8% increase), there were no changes vs the registry total (1%). The median number of procedures per center was 2 (P25-75, 1-7). The success rate was 82%. Mapping systems predominated (90% of procedures) and 11% were fluoroscopy-free. The main ablation targets were dilated cardiomyopathy (49%), arrhythmogenic right ventricular cardiomyopathy (19%), and congenital heart disease (9%). Less commonly treated ablation targets were nondilated cardiomyopathy (6%), hypertrophic cardiomyopathy (4%), and bundle branch re-entrant tachycardia (3%). Other targets, such as sarcoidosis, valvular heart diseases, and those associated with muscular dystrophy, myocarditis, and Chagas disease, were very rare. Irrigated-tip catheters with contact forcesensing technology were the most commonly used catheters (92%), followed by standard irrigated catheters and nonirrigated catheters. Although still rare, radioablation was more commonly used than in 2023, increasing from 9 procedures to 23. Ethanol ablation was applied in only 1 procedure, and the use of cryoablation was not reported. Retroaortic was the most common access route (39%), followed by transseptal (32%) and right ventricular endocardial (20%), with 12% exclusively epicardial and 18% combined endocardial-epicardial. In total, 59% of procedures were performed under general anesthesia and 18% with deep sedation. Hemodynamic support devices were used in 2% of procedures. Just 4.4% of the procedures were performed on an outpatient basis. Overall, 21 complications were recorded (5.1%) (table 3). Two patients died, 1 from hemorrhagic shock and 1 from arterial dissection.

A total of 522 ablations in pediatric patients were performed in 44 centers (38%), 1.6% of the total registry and a 12% increase compared with 2023. The median number of procedures was 4 (P25-75, 1-10) while the median age was 12 years. Once again, the most frequently treated ablation target was APs: 347 procedures (66%). The success rate was 92.5%. The second most commonly treated ablation target was AVNRT, with 127 procedures (24%) and a 91.3% success rate. This was followed by FAT, with 24 procedures (4.6%) and an 83.3% success rate, and IVT, with 14 procedures (2.7%) and a 100% success rate. The frequencies of the other ablation targets were much lower: NICM-VT (2 procedures), ICT (3 procedures), and MAT (3 procedures) (figure 7). The predominant energy source was radiofrequency (94%), with limited use of cryoablation (6%).

Figure 7.

Relative proportions of ablation targets in pediatric patients (< 15 years). AP, accessory pathway; AVNRT, atrioventricular nodal reentrant tachycardia; CTI, cavotricuspid isthmus; FAT, focal atrial tachycardia; ICM-VT, ischemic cardiomyopathy ventricular tachycardia; IVT, idiopathic ventricular tachycardia; MAT, macrore-entrant atrial tachycardia.

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The percentage of ablation procedures performed using electroanatomic mapping systems was similar to that of previous years (54%). These systems were most commonly used for all types of ventricular tachycardias (95% overall), as well as MAT (96%) and FAT (78%) (table 4). They were used for just 47.5% of AF ablations.

In addition, 17% of the ablation targets were treated without fluoroscopy. In particular, 40% of AVNRT ablations and 30% of CTI ablations were fluoroscopy-free.

There was little change in the number of centers performing cardioneuroablation (42 vs 41 in 2023; table 2), with 185 procedures (a 30% increase). The acute success rate was 96%. In total, 78% of procedures were performed for syncope, and most (89%) involved treatment of both atria using irrigated-tip catheters with contact forcesensing technology.

Accreditation process for interventional cardiac electrophysiologists in Spain

The changes over time in the accreditation system are shown in figure 8. A clear upward trend is evident in both indicators, although their behaviors differ. The number of centers grew steadily, from 17 in 2010 to 41 in 2024, which enabled the standard accreditation pathway to be established based on formal training. In contrast, individual accreditations exhibited some year-to-year variability, influenced by various factors, such as training capacity and extraordinary events. A notable example is 2022, when no examination was held due to a lack of candidates (figure 8), a situation attributed to the ongoing impact of the SARS-CoV-2 pandemic on clinical and training activity. However, the system has since shown a clear recovery, with a new rebound expected in 2025, reflecting renewed interest and operational capacity.

Figure 8.

Changes over time in the number of accredited professionals and centers. The line indicates the cumulative number of accredited centers, while the bars denote the number of accredited professionals per year.

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