Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom; Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom.
Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom.
Heart Rhythm. 2024 Sep;21(9):1537-1544. doi: 10.1016/j.hrthm.2024.05.032. Epub 2024 May 17.
With the exponential growth of catheter ablation for atrial fibrillation (AF), there is increasing interest in associated health care costs. Pulsed field ablation (PFA) using a single-shot pentaspline multielectrode catheter has been shown to be safe and effective for AF ablation, but its cost efficiency compared to conventional thermal ablation modalities (cryoballoon [CB] or radiofrequency [RF]) has not been evaluated.
The purpose of this study was to compare cost, efficiency, effectiveness, and safety between PFA, CB, and RF for AF ablation.
We studied 707 consecutive patients (PFA: 208 [46.0%]; CB: 325 [29.4%]; RF: 174 [24.6%]) undergoing first-time AF ablation. Individual procedural costs were calculated, including equipment, laboratory use, and hospital stay, and compared between ablation modalities, as were effectiveness and safety.
Skin-to-skin times and catheter laboratory times were significantly shorter with PFA (68 and 102 minutes, respectively) than with CB (91 and 122 minutes) and RF (89 and 123 minutes) (P < .001). General anesthesia use differed across modalities (PFA 100%; CB 10.2%; RF 61.5%) (P < .001). Major complications occurred in 1% of cases, with no significant differences between modalities. Shorter procedural times resulted in lower staffing and laboratory costs with PFA, but these savings were offset by substantially higher equipment costs, resulting in higher overall median costs with PFA (£10,010) than with CB (£8106) and RF (£8949) (P < .001).
In this contemporary real-world study of the 3 major AF ablation modalities used concurrently, PFA had shorter skin-to-skin and catheter laboratory times than did CB and RF, with similarly low rates of complications. However, PFA procedures were considerably more expensive, largely because of higher equipment cost.
随着房颤（AF）导管消融术的指数级增长，人们对相关医疗保健成本的兴趣日益浓厚。使用单次五边形多电极导管的脉冲场消融（PFA）已被证明对 AF 消融安全有效，但与传统热消融方式（冷冻球囊[CB]或射频[RF]）相比，其成本效益尚未得到评估。
本研究旨在比较 PFA、CB 和 RF 用于 AF 消融的成本、效率、效果和安全性。
我们研究了 707 例连续接受首次 AF 消融的患者（PFA：208[46.0%]；CB：325[29.4%]；RF：174[24.6%]）。计算了包括设备、实验室使用和住院时间在内的各个程序的成本，并比较了消融方式之间的成本、效果和安全性。
PFA 的皮肤到皮肤时间和导管实验室时间分别明显短于 CB（分别为 68 分钟和 102 分钟）和 RF（分别为 89 分钟和 123 分钟）（P<0.001）。不同方式下全身麻醉的使用情况不同（PFA 100%；CB 10.2%；RF 61.5%）（P<0.001）。主要并发症发生率为 1%，各方式间无显著差异。PFA 程序时间较短导致人员配备和实验室成本降低，但这些节省被设备成本的大幅增加所抵消，导致 PFA 的总体中位数成本高于 CB（£10010）和 RF（£8949）（P<0.001）。
在这项同时使用的 3 种主要 AF 消融方式的当代真实世界研究中，PFA 的皮肤到皮肤时间和导管实验室时间短于 CB 和 RF，并发症发生率相似。然而，PFA 手术费用要高得多，主要是因为设备成本较高。
