Radiofrequency ablation versus cryoablation for atrioventricular nodal re-entrant tachycardia in children: a value comparison.

BACKGROUND: It is unclear whether cryoablation or radiofrequency ablation offers better value for treating atrioventricular nodal re-entrant tachycardia in children. We aimed to compare the value of these procedures for treating atrioventricular nodal re-entrant tachycardia in children, with value being outcomes relative to costs. METHODS: We performed a retrospective cohort study of all atrioventricular nodal re-entrant tachycardia ablations for children (age⩽18 years) from July, 2009 to June, 2011 at our institution. Costs included fixed costs, miscellaneous hospital costs, and labour costs, and key outcomes were acute and long-term success (6 months) of the ablations. We conducted T-tests and regression analyses to investigate the associations between the ablation procedure type and the cost and success of the ablations. RESULTS: Of 96 unique cases performed by three paediatric electrophysiologists, 48 were cryoablation only, 42 radiofrequency ablation only, and six were a combination. Acute success was 100% for the cryoablation only and radiofrequency ablation only cases and 83% for the combination cases. There were no notable adverse events. The average total cost was $9636 for cryoablation cases, $9708 for radiofrequency ablation cases, and $10,967 for combination cases (p=0.51 for cryoablation only versus radiofrequency ablation only). The long-term success rate was 79.1% for cryoablation only, 92.8% for radiofrequency ablation only, and 66.7% for the combination (p=0.01 for cryoablation only versus radiofrequency ablation only), but long-term success varied notably by provider. CONCLUSIONS: Cryoablation and radiofrequency ablation offer similar value in the short term for the treatment of atrioventricular nodal re-entrant tachycardia in children. Differences in long-term success may vary substantially by physician, and thus may lead to differences in long-term value.

Cardiac resynchronisation therapy in patients with atrioventricular nodal disease and reduced ejection fraction - can we afford it?

BACKGROUND: Recent pacing guidelines from the European Society of Cardiology recommend cardiac resynchronisation therapy (CRT) in patients with an atrioventricular (AV) nodal pacing indication and reduced ejection fraction (EF). However, concerns over added expenditure may limit its widespread implementation. We investigate the potential incremental cost of biventricular over right ventricular pacing if such a practice was adopted. METHODS: Retrospective analysis was performed of devices implanted over eight years. The database was analysed for device type, pacing indication and EF. Cost analysis was performed. RESULTS: 1751 devices were implanted over eight years at an averaged cost of AUD$1,369,125 per year. 172 with CRT were excluded. 25.4 (11.6%) patients per year had an EF≤50% and AV nodal disease. 18.4 were in sinus rhythm (SR) and 7.0 in atrial fibrillation (AF). Of these, 13.5 (6.2%) had EF≤45% (9.9 SR, 3.6 AF) and 8.2 (3.8%) had EF≤35% (5.6 SR, 2.6 AF). Based on an incremental cost of $4,000 per device, if all patients with EF≤50% received CRT, the total cost increment per year equates to $73,500 for SR patients or $101,500 if AF patients were included. In patients with EF≤35% and EF≤45%, this amounts to $22,500 and $39,500 per year for SR patients respectively or $33,000 and $54,000 per year if AF patients were included. Depending on the EF and rhythm, this represents a 1.6% to 7.4% increase per year in the pacing budget for an increased patient population of between 2.6% (EF≤35% in SR) to 11.6% (EF≤50%). CONCLUSION: A small proportion of additional patients will qualify for CRT based on the chosen cut-off and rhythm. Although the individual incremental cost for biventricular over right ventricular pacing is high in patients with AV nodal disease and reduced EF, overall this represents at most, a modest increase in the total pacing budget.

Comparison of the cost of radiofrequency catheter modification of the atrioventricular node and medical therapy for drug-refractory atrioventricular node reentrant tachycardia.

The purpose of this study was to determine the charges for radiofrequency catheter modification of the atrioventricular (AV) node in 15 patients with symptomatic AV node reentrant tachycardia despite pharmacologic therapy and to compare these charges with the estimated charges for health care utilization by the same patients before the catheter procedure was performed. There were seven men and eight women with a mean age of 50 +/- 17 years. The mean duration and frequency of symptoms were 16 +/- 9 years and 4.5 +/- 6 episodes/month, respectively. Fourteen of the 15 patients required only one procedure for diagnosis and cure of AV node reentrant tachycardia and 1 patient required two sessions. All patients underwent electrophysiologic study before discharge from the hospital to confirm the short-term efficacy of the procedure. The mean duration of the hospital stay was 3 +/- 1.5 days and the mean total charge/patient expressed in 1991 dollars was $15,893 +/- $3,338 for catheter modification. These total charges consisted of hospital charges of $8,105 +/- $2,466 and physician charges of $7,788 +/- $971. All patients had a successful outcome and required no additional antiarrhythmic therapy. The estimated cost of health care utilization for these 15 patients before cure of AV node reentrant tachycardia was $7,651/patient per year. These estimated costs included charges incurred for emergency room visits, office visits, hospitalizations and antiarrhythmic drug therapy. In conclusion, the results of this study indicate that the annual health care costs incurred by patients who have symptomatic, drug-refractory paroxysmal supraventricular tachycardia caused by AV node reentry are substantial.(ABSTRACT TRUNCATED AT 250 WORDS)