Oster Matthew E, Yang Zhou, Stewart-Huey Kay, Glanville Michelle, Porter Arlene, Campbell Robert, Webb Brad, Strieper Margaret
1Children's Healthcare of Atlanta,Emory University Rollins School of Public Health,Atlanta, GA,United States of America.
3Department of Health Policy and Management,Emory University Rollins School of Public Health,Atlanta, GA,United States of America.
Cardiol Young. 2017 Mar;27(2):224-228. doi: 10.1017/S1047951116000299. Epub 2016 Apr 18.
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.
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.
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.
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.
冷冻消融术和射频消融术在治疗儿童房室结折返性心动过速方面，哪种方法性价比更高尚不清楚。我们旨在比较这两种手术方法治疗儿童房室结折返性心动过速的价值，价值即相对于成本的治疗效果。
我们对2009年7月至2011年6月在我院进行的所有儿童（年龄≤18岁）房室结折返性心动过速消融术进行了回顾性队列研究。成本包括固定成本、医院杂项成本和人工成本，关键结果是消融术的急性和长期成功率（6个月）。我们进行了T检验和回归分析，以研究消融手术类型与消融成本及成功率之间的关联。
三位儿科电生理学家共进行了96例独特手术，其中48例仅采用冷冻消融术，42例仅采用射频消融术，6例为联合手术。仅冷冻消融术和仅射频消融术病例的急性成功率为100%，联合手术病例为83%。未出现明显不良事件。冷冻消融术病例的平均总成本为9636美元，射频消融术病例为9708美元，联合手术病例为10967美元（仅冷冻消融术与仅射频消融术相比，p = 0.51）。仅冷冻消融术的长期成功率为79.1%，仅射频消融术为92.8%，联合手术为66.7%（仅冷冻消融术与仅射频消融术相比，p = 0.01），但长期成功率因手术医生不同而有显著差异。
冷冻消融术和射频消融术在短期内治疗儿童房室结折返性心动过速的价值相似。长期成功率的差异可能因医生而异，进而可能导致长期价值的差异。
