title: Atrial fibrillation ablation: a cost or an investment?
abstract: In the last decade, catheter ablation (CA) became a viable therapeutic approach for symptomatic patients with atrial fibrillation (AF) non-responsive to antiarrhythmic drugs (AAD). The economic analysis of CA is complex due to the presence of several confounding factors, such as the pattern of AF (paroxysmal AF, persistent or long-term persistent AF), the patient population (age, presence/absence of underlying structural heart disease, comorbidities, etc.), the different techniques for ablation (with impact on complexity and cost of the procedure, as well as on efficacy and safety), and the learning curve and experience of an individual centre (with impact on efficacy and cost effectiveness). At present, CA appears to be cost effective mainly in patients with paroxysmal AF who are refractory to AADs, especially if the success of the procedure and, thus, the benefit in quality of life remains >5 years, with a low complication rate. More data are needed on cost effectiveness of CA of persistent and long-term persistent AF or of AF associated with heart failure. Atrial fibrillation ablation is unlikely to be cost effective for patients who have preserved quality of life despite their AF or for patients whose quality of life is not expected to improve substantially despite elimination of AF (e.g. patients with poor quality of life mainly due to other health problems). These observations may help in the selection of candidates for AF ablation.
authors.affiliation: Department of Cardiology, Institute for Clinical and Experimental Medicine, Vídeňská 1958/9, 140 21 Prague 4, Czech Republic. josef.kautzner@medicon.cz
authors.forename: Josef
authors.initials: J
authors.lastname: Kautzner
authors.forename: Veronika
authors.initials: V
authors.lastname: Bulkova
authors.forename: Gerhard
authors.initials: G
authors.lastname: Hindricks
authors.forename: Nikos
authors.initials: N
authors.lastname: Maniadakis
authors.forename: Paolo
authors.initials: P
authors.lastname: Della Bella
authors.forename: Pierre
authors.initials: P
authors.lastname: Jaïs
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Kuck
mesh_terms: D001145:Arrhythmias, Cardiac / Q000191:economics* / Q000401:mortality / Q000601:surgery*; D017115:Catheter Ablation / Q000191:economics* / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000191:economics*; D005060:Europe / Q000453:epidemiology; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007449:Investments / Q000706:statistics & numerical data; D015995:Prevalence; D016019:Survival Analysis; D015996:Survival Rate