First Time Ablation for Patients With Paroxysmal Atrial Fibrillation – Budget Impact of Different Modalities in the Real World

OBJECTIVES: Pulmonary vein isolation (PVI) is the standard treatment for patients with drug-refractory symptomatic paroxysmal atrial fibrillation (PAF), usually by radiofrequency (RF) or cryoablation. Cryoablation is performed under sedation and is generally a shorter procedure. We compared the budget impact of both modalities.

METHODS: All patients over 12 months (April 2019 to March 2020) who underwent first time PVI were studied. Patients undergoing other ablation at the time of PVI were excluded. RF ablation using the Biosense Webster SmartTouch SF ablation catheter and CARTO 3 mapping system, or cryoablation using the Medtronic Arctic Front Advance Cryoballoon were performed. A retrospective analysis of hospital redo rates, time in catheter lab (patient-in to patient-out), use of anaesthetic and length of stay using the different modalities was carried out. Staffing and consumable costs were taken from NHS costings and NICE AF clinical guidelines respectively.

RESULTS: 116 procedures (84 RF, 32 cryoballoon) were performed over the period. No statistical differences were seen in age (65.1 vs 66.0, p=0.87), left atrial size (3.9 vs 4.1cm, p=0.26) and left ventricular ejection fraction (61.7 vs 62.9%, p=0.26) between the 2 groups of patients. Time in catheter lab was significantly longer using RF (162 vs 103 minutes, p<0.001). Same day discharge rate was not statistically different between the groups. Redo rates at 2 years were 11% with RF and 19% with cryoablation. The budget impact analysis demonstrated a 24-month saving of £1853 per patient treated with RF compared to cryoablation.

CONCLUSIONS: This real-world experience demonstrates low redo rates are a key driver of value-based healthcare in first time PAF ablations. We found that redo procedure rates at 2 years were less with patients undergoing RF ablation. A substantial cost saving could be achieved if all patients underwent RF ablation initially for the treatment of PAF in our centre.