THE ASSESSMENT OF CLINICAL AND ECONOMIC EFFECTIVENESS OF RADIOFREQUENCY ABLATION WITH IMPLANTED CARDIAC DEVICES IN PATIENTS WITH ATRIAL FIBRILLATION. LITERATURE REVIEW
Introduction. Atrial fibrillation (AFib) is a health condition in which irregular heartbeats are registered in the chambers of the heart. The condition is characterized by the risk of developing blood clots which may lead to stroke.
Objective. To evaluate the clinical and cost-effectiveness and safety of radiofrequency ablation (RFA) with implanted cardiac devices versus the Cox-Maze procedure (CM) in drug-resistant patients with AFib.
Search strategy. PubMed, the Cochrane Library, NICE, and CADTH Evidence Driven have been used for the literature search. Search filters: systematic reviews, meta - analyzes, randomized controlled trials (RCTs); population: humans; date of publication: 5 -20 years. To assess the quality of systematic reviews and meta-analyses, we used the AMSTAR checklist. The ELSI checklist has been applied in order to check RFA for potential ethical, social and legal aspects. The article was peer-reviewed by two independent public health professionals.
Results. The success rates of RFA varied and might be explained by AFib types and an electrophysiologist’s clinical experience. From the safety standpoint, the technology may cause rare complications (3-5%) as bleeding, thromboembolism, the pacemaker syndrome and some interactions with cardiac devices such as oversensing or transvenous lead dislodgment. From the societal implications, RFA improves patients’ recovery and allows them to be discharged from the clinic in 2-3 days so that it saves hospital resources, whereas CM requires the patients to stay in the hospital for 4 to 6 weeks.
Conclusions. RFA with implanted cardiac devices is clinically effective and generally safe for the treatment of AFib in drug-resistant patients. Also, the health technology is potentially cost - effective and resource-saving for hospitals. Nonetheless, its clinical effects and economic implications in the long turn should be further investigated.
Zhandos L. Salpynov*1, https://orcid.org/0000-0002-9268-3296
Kamilla K. Gaitova1, Adlet B. Tabarov1,
Zaid K. Zholdassov1, Tanja Novakovic2,
Mark Parker2, https://orcid.org/0000-0001-6007-0842
Andrey V. Avdeyev3, https://orcid.org/0000-0001-8509-6053
1 The Republican state enterprise on the right of economic management «Republican Centre for Health Development» of the Ministry of Health of the Republic of Kazakhstan, Centre for Economics and Health Technology Assessment, Nur-Sultan, Republic of Kazakhstan;
2 ZEM Solutions, Belgrade, Serbia;
3 The Republican state enterprise on the right of economic management «Medical Center Hospital of the President’s Affairs Administration of the Republic of Kazakhstan», Nur-Sultan, Republic of Kazakhstan
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8. Darrat Y., Morales G., Elayi C. The Effects of Catheter Ablation on Permanent Pacemakers and Implantable Cardiac Defibrillators. Journal Of Innovations In Cardiac Rhythm Management. 2017, 8(3). pp. 2630-2635. doi: 10.19102/icrm.2017.080303.
9. Dunning J., Nagendran M., Alfieri O., Elia S., Kappetein A., Lockowandt U. et al. Guideline for the surgical treatment of atrial fibrillation. European Journal Of Cardio-Thoracic Surgery. 2013, 44(5), pp. 777-791. doi: 10.1093/ejcts/ezt413.
10. Ganesan A., Brooks A., Roberts-Thomson K., Lau D., Kalman J., Sanders P. Role of AV Nodal Ablation in Cardiac Resynchronization in Patients With Coexistent Atrial Fibrillation and Heart Failure. Journal Of The American College Of Cardiology. 2012, 59(8), pp. 719-726. doi: 10.1016/j.jacc.2011.10.891.
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13. Kong M., Lopes R., Piccini J., Hasselblad V., Bahnson T., Al-Khatib S. Systematic review: Surgical Maze Procedure as a Treatment for Atrial Fibrillation: A Meta-Analysis of Randomized Controlled Trials. Cardiovascular Therapeutics. 2010, 28(5), pp. 311-326. doi: 10.1111/j.1755-5922.2010.00139.x
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16. McKenna C., Palmer S., Rodgers M., Chambers D., Hawkins N., Golder S. et al. Cost-effectiveness of radiofrequency catheter ablation for the treatment of atrial fibrillation in the United Kingdom. Heart. 2008, 95(7), pp. 542-549. doi: 10.1136/hrt.2008.147165.
17. Noorani H.Z., Yee R., Marshall D., Connolly S., Nichol G., O'Brien B. Radiofrequency catheter ablation for cardiac arrhythmias: a clinical and economic review. Technology report № 25, Ottawa: Canadian Coordinating Office for Health Technology Assessment 2002, pp. 1-75.
18. Ruaengsri C., Schill M., Khiabani A., Schuessler R., Melby S., Damiano R. The Cox-maze IV procedure in its second decade: still the gold standard? European Journal Of Cardio-Thoracic Surgery. 2018, 53(suppl_1),pp. i19-i25. doi: 10.1093/ejcts/ezx326.
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26. Yang Y., Ortendahl J. How does the Cox maze procedure compare? Cost-effectiveness analysis of alternative treatments of atrial fibrillation. Current Medical Research and Opinion. 2018, 35(6), pp. 957-961. doi: 10.1080/03007995.2018.1546681.
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Салпынов Ж.Л., Гаитова K.K., Taбаров A.Б., Жолдасов З.K., Новакович T., Паркер M., Aвдеев A.В. Оценка клинической и экономической эффективности радиочастотной абляции с имплантацией сердечных устройств у пациентов с фибрилляцией предсердий. Литературный обзор // Наука и Здравоохранение. 2020. 3 (Т.22). С. 32-41. doi:10.34689/SH.2020.22.3.006Похожие публикации:
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