Pierucci Nicola, Bruti Raffaele M, Cipollone Pietro, Mariani Marco V, Laviola Domenico, Palombi Marta, Trivigno Sara, Spadafora Luigi, Bernardi Marco, Barca Luca, Mascia Giuseppe, LA Fazia Vincenzo M, D'Amato Andrea, Matteucci Andrea, Schiavone Marco, Pandozi Claudio, Severino Paolo, Lavalle Carlo
Department of Cardiovascular, Respiratory, Nephrological, Anesthesiologic and Geriatric Sciences, Sapienza University, Rome, Italy -
Department of Cardiovascular, Respiratory, Nephrological, Anesthesiologic and Geriatric Sciences, Sapienza University, Rome, Italy.
Minerva Cardiol Angiol. 2025 Jul 14. doi: 10.23736/S2724-5683.25.06782-1.
Atrial fibrillation (AF) is a prevalent and significant health concern, imposing a substantial economic burden on healthcare systems worldwide. The condition is associated with an increased risk of stroke, heart failure and other comorbidities, contributing to heightened morbidity and mortality rates amongst those affected. Healthcare resource utilization and costs associated with the treatment and management of AF have become a pressing concern, particularly in the context of recurrent episodes. Catheter ablation (CA) has been demonstrated to have positive effects on relieving the economic burden of AF. The aim of this review is to evaluate the economic burden of AF and analyze the cost-efficiency of CA compared to pharmacological treatments, particularly in patients with drug-refractory AF. This narrative review is focused on manuscripts, derived from the NCBI (PubMed) online database, which deal with the economic burden of AF through the analysis of direct and indirect costs and benefits of various therapeutic options, concentrating on CA compared to drug management alone. The economic burden of AF varies widely across healthcare systems, with direct costs ranging from $ 2000 to $ 60,000 per patient per year. The review confirms that CA, despite its higher initial costs ($ 27,000-38,000 per procedure in the USA), provides long-term financial benefits. Across the analyzed studies, CA led to a 20-40% reduction in hospitalization rates, a 15-30% decrease in emergency department visits, and a significant reduction in medication use, particularly in antiarrhythmic drugs and anticoagulants. Cost-utility analyses indicate that CA is cost-effective, with incremental cost-effectiveness ratios (ICER) ranging from $ 6000 to $ 60,000 per quality-adjusted life year (QALY). Furthermore, studies demonstrate a 10-20% improvement in quality-of-life scores for patients undergoing CA compared to those on pharmacological therapy alone. CA is a cost-efficient strategy for managing AF, especially in patients with symptomatic, drug-refractory AF. The procedure provides both long-term economic benefits by reducing healthcare resource utilization and favorable socio-economic effects by improving quality of life. Future studies should continue to explore the broader economic impact of AF management, including indirect costs such as lost productivity and caregiver burden.
