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Aims To describe long-term real-world trends in atrial fibrillation (AF) ablation practice at a high-volume UK tertiary centre and to quantify changes in ablation modality, procedural efficiency, fluoroscopy exposure and radiation dose over eleven years, with particular focus on the transition from radiofrequency ablation (RFA) and cryoballoon ablation (CBA) to pulsed field ablation (PFA).Methods This retrospective observational study included all consecutive AF ablation procedures performed between April 2014 and June 2025. Procedural data were extracted from electronic hospital systems and included ablation modality, skin-to-skin procedure time, fluoroscopy time and dose area product (DAP). Ablations for atrial flutter or accessory pathways were excluded. Subgroup analyses examined temporal changes within RFA, CBA and PFA cohorts. Yearly medians were compared to assess temporal trends.Results A total of 2862 AF ablation procedures were analysed. RFA accounted for 1878 procedures (66%), CBA for 735 (26%), and PFA for 249 (9%). RFA dominated early practice, peaking in 2015, and remained the most frequently used modality until 2019. RFA use declined steadily after 2020, reaching 72 procedures in early 2025. CBA was introduced in 2016, increased rapidly to a peak of 138 cases in 2018, and then declined in subsequent years. PFA was introduced in 2023 and experienced rapid uptake, reaching 98 cases in 2024 and 95 in early 2025.Median procedure time decreased substantially over the study period, from 205 minutes in 2014 to 104 minutes in 2025. RFA procedure time declined from 205 to 156 minutes, with further reductions observed after the adoption of high-power short-duration (HPSD) ablation strategies in 2021. CBA procedure time fell from 115 minutes in 2016 to 83 minutes in 2023, with modest increases thereafter. PFA demonstrated the shortest procedure times, decreasing from 84 minutes in 2023 to 69 minutes in 2025.Fluoroscopy time declined consistently across the study period, from a median of 32 minutes in 2014 to 13 minutes in 2025. RFA fluoroscopy time decreased from 27 to 15 minutes, CBA from 27 to 17 minutes, and PFA from 25 to 17 minutes over their respective adoption periods. Differences in fluoroscopy exposure between modalities were significant in 2023 and 2024, with convergence by 2025.Radiation exposure showed a marked reduction over time. Median DAP decreased from 3405 Gy.cm2 in 2014 to 782 Gy.cm2 in 2025. RFA was associated with the highest median DAP (840 Gy.cm2), followed by CBA (695 Gy.cm2), whereas PFA demonstrated the lowest radiation exposure (607 Gy.cm2). General anaesthesia (GA) was used in 29% of all procedures, but in 90% of PFA cases (figure 1).Conclusion Over 11 years, AF ablation practice at our centre evolved from a predominant use of RFA and CBA toward a rapid and sustained adoption of PFA. This transition was accompanied by substantial improvements in procedural efficiency and reductions in fluoroscopy and radiation exposure, reflecting a shift in contemporary electrophysiology workflows toward PFA as the dominant ablation strategy.