Authors' objectives:

The objectives of this report are:

(1) to evaluate the evidence for the clinical efficacy of catheter ablation delivered by radiofrequency energy (RFA) through a systematic review of research studies, and (2) to evaluate the cost-effectiveness of RFA through a systematic review of economic evaluations.

The purpose of this review is to inform decision-makers about the current evidence-base of catheter ablation for cardiac arrhythmias and of the future implications and technological advances of the procedure. This report is a collaborative project with the Canadian Cardiovascular Society.

Authors' results and conclusions: RFA of paroxysmal supraventricular tachycardia (pre-excitation syndromes, AV node re-entry), atrial flutter and focal atrial tachycardias are all procedures associated with high procedural success rates (>75%) that are sustained during a follow-up period of one to two years. Complication rates in most of these studies are reported to be close to five per cent. Limited evidence also demonstrates that elimination of these tachycardias improves symptoms and/or quality of life. The clinical benefits of atrial flutter ablation are diminished in patients with concomitant atrial fibrillation (AF). Clinical efficacy data for RFA of AF, and ventricular tachycardia (VT) secondary to underlying structural heart disease, are less conclusive than those of the above tachycardias.

Authors' recommendations: Catheter ablation for most cardiac arrhythmias is associated with good procedural success rates but there remains insufficient evidence to draw specific conclusions about its long-term clinical efficacy and cost-effectiveness. RFA is considered primarily as an adjunct procedure to pacemaker implantation for atrial fibrillation (AF), and to antiarrhythmic drugs and implantable cardioverter defibrillator therapy for ventricular tachycardia (VT). For all the different types of ablation procedures, there is a paucity of high quality outcome studies comparing ablation with alternative therapies. There exist no Canadian guidelines for catheter ablation but current practices do not appear to vary markedly from the guidelines or recommendations made by international specialty societies. If future evidence from controlled trials, especially in patients with AF and atrial flutter, demonstrates more conclusive benefits of ablation as technique and experience advance, utilization could climb significantly.

Authors' methods: Systematic review, Economic evaluation

Project Status: Completed

URL for project: https://www.ccohta.ca/

Year Published: 2002

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Canadian Coordinating Office for Health Technology Assessment

Contact Address: 600-865 Carling Avenue, Ottawa, ON K1S 5S8 Canada. Tel: +1 613 226 2553, Fax: +1 613 226 5392;

Contact Name: requests@cadth.ca

Contact Email: requests@cadth.ca

Copyright: Canadian Coordinating Office for Health Technology Assessment (CCOHTA)