CATHETER ABLATION IN ATRIAL FIBRILLATION

Curative catheter ablation in atrial fibrillation and typical atrial flutter: systematic review and economic evaluation

Background

Atrial fibrillation (AF) and typical atrial flutter are common and debilitating abnormalities of the heart rhythm (arrhythmias). There are two broad strategies for the management of AF and atrial flutter. Rhythm control strategies attempt to control the arrhythmia by restoring and maintaining a normal heart rhythm (sinus rhythm) while rate control strategies involve control of heart rate without attempting to remove the underlying arrhythmia. Radiofrequency catheter ablation (RFCA) involves the percutaneous insertion of catheters which are guided by fluoroscopy to the heart. Small areas of tissue responsible for the propagation of abnormal electrical activity through the heart are selectively destroyed (ablated) using radiofrequency energy to restore normal sinus rhythm.  Technical aspects of RFCA continue to evolve such that the clinical studies represent experience with many variations in equipment and technique. The aim of this project was to determine the safety, clinical effectiveness and cost-effectiveness of RFCA for the curative treatment of) AF and typical atrial flutter.

Findings

The available evidence suggests that RFCA is a relatively safe and efficacious procedure for the therapeutic treatment of AF and typical atrial flutter.  There is some randomized evidence to suggest that RFCA is superior to AADs in patients with drug-refractory paroxysmal AF, in terms of freedom from arrhythmia at 12 months.  RFCA appears clearly cost-effective if the observed quality of life benefits are assumed to continue over a patient’s lifetime.  However, there remain uncertainties around longer-term effects of the intervention and the extent to which published effectiveness findings can be generalised to ‘typical’.

Conducted by: M Rodgers1, C McKenna2, S Palmer2, D Chambers1, S Van Hout2, S Golder1, C Pepper3, D Todd4, N Woolacott1

1. Centre for Reviews and Dissemination; 2. Centre for Health Economics; 3. Yorkshire Heart Centre; The Cardiothoracic Centre, Liverpool NHS Trust

Further details

Project page on HTA Programme website

Publications

Chambers D, Rodgers M, Woolacott N. Not only randomized controlled trials, but also case series should be considered in systematic reviews of rapidly developing technologies. J Clin Epidemiol. 2009; 62(12):1253-1260

McKenna C, Palmer S, Rodgers M, Chambers D, Palmer S, Hawkins N, Golder S, Van Hout S, Pepper C, Todd D, Woolacott N. Cost-effectiveness of radiofrequency catheter ablation for the treatment of atrial fibrillation in the UK. Heart. 2009; 95(7): 542-9

Rodgers M, McKenna C, Palmer S, Chambers D, Van Hout S, Golder S, Pepper C, Todd D, Woolacott N. Curative catheter ablation in atrial fibrillation and typical atrial flutter: systematic review and economic evaluation. Health Technol Assess. 2008; 12(34): 1-220

Posters

Rodgers M, Chambers D, Woolacott N. To randomise or not to randomise: a matter of perspective? Cochrane Colloquium 2008. Freiburg, Germany, 3 - 7 October 2008

Chambers D, Rodgers M, Golder S, Pepper C, Todd D, Woolacott N. Methodological issues in a systematic review of a rapidly developing intervention: catheter ablation for atrial fibrillation. HTAi Annual Meeting 2007. Barcelona, Spain, 1 July 2007

Funding

Commissioned by the HTA Programme on behalf of NICE's Technology Assessment Report (TAR) process