University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada; Departament de Medicina, Universitat de Barcelona and Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain.
University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
Can J Cardiol. 2019 Feb;35(2):169-177. doi: 10.1016/j.cjca.2018.10.011. Epub 2018 Oct 25.
Catheter ablation of ventricular tachycardia (VT) can reduce the burden of ventricular arrhythmia (VA) but its effect on health care utilization and costs after such therapy is poorly known. We sought to compare the rates of cardiovascular (CV)-related hospitalizations, survival, and health care costs in patients with recurrent VT treated either with VT ablation or with medical therapy.
One-hundred implantable cardioverter-defibrillator patients with structural heart disease who underwent VT ablation were included. Propensity score-matched patients with recurrent VT treated with medical therapy were identified from a prospective registry of approximately 7000 de novo implantable cardioverter-defibrillator patients. Outcomes and costs were ascertained using health administrative databases.
Among patients who underwent VT ablation, the cumulative rates of VA-related hospitalizations were lower in the 2 years after their ablation procedure compared with the year before (rate ratio, 0.3; 95% confidence interval [CI], 0.22-0.43). Rates of CV-related hospitalization and hospitalization because of VA post index date were similar between the VT ablation and medical therapy groups (hazard ratio [HR], 0.94; 95% CI, 0.57-1.54 and HR, 1.04; 95% CI, 0.57-1.91, respectively). Health care costs in the VT ablation patients were not increased post-ablation compared with the medical management group. The risk of all-cause mortality was lower among patients in the VT ablation group relative to the medical therapy group (HR, 0.64; 95% CI, 0.4-0.99).
Patients who underwent VT ablation experienced a significant reduction in their rate of VA-related hospitalizations. Patients treated with VT ablation had similar rates of CV-related hospitalization compared with those treated with medical therapy without increased health care-related costs.
导管消融治疗室性心动过速（VT）可以减轻室性心律失常（VA）的负担，但这种治疗后对医疗保健利用和成本的影响知之甚少。我们旨在比较结构性心脏病患者接受 VT 消融治疗或药物治疗后，复发性 VT 患者的心血管（CV）相关住院率、生存率和医疗保健费用。
纳入了 100 名接受 VT 消融治疗的植入式心脏复律除颤器患者。从大约 7000 名新发植入式心脏复律除颤器患者的前瞻性登记处确定了接受药物治疗且复发性 VT 治疗的匹配患者。使用健康管理数据库确定结局和成本。
在接受 VT 消融治疗的患者中，与消融前一年相比，消融后两年 VA 相关住院率较低（比率比，0.3；95%置信区间[CI]，0.22-0.43）。在指数日期后，VT 消融组和药物治疗组之间 CV 相关住院率和因 VA 住院率相似（风险比[HR]，0.94；95%CI，0.57-1.54 和 HR，1.04；95%CI，0.57-1.91）。与药物治疗组相比，VT 消融组患者的医疗保健费用在消融后并未增加。与药物治疗组相比，VT 消融组患者的全因死亡率较低（HR，0.64；95%CI，0.4-0.99）。
接受 VT 消融治疗的患者 VA 相关住院率显著降低。与接受药物治疗的患者相比，接受 VT 消融治疗的患者的 CV 相关住院率相似，且没有增加与医疗保健相关的成本。
