Radiofrequency catheter ablation of the pulmonary veins for treatment of atrial fibrillation
BlueCross BlueShield Association
Record ID 32010000223
English
Authors' objectives:
The objective of this Assessment is to determine whether radiofrequency catheter ablation improves health outcomes when used as a treatment for patients with atrial fibrillation. Three indications for radiofrequency catheter ablation are addressed: 1) patients with recent onset paroxysmal atrial fibrillation, as first-line treatment; 2) patients with symptomatic paroxysmal or persistent atrial fibrillation, who have failed treatment with antiarrhythmic drugs; 3) patients with class II or III congestive heart failure and symptomatic atrial fibrillation, in whom heart rate is poorly controlled by standard medications, as an alternative to atrioventricular (AV) nodal ablation and pacemaker implantation.
Authors' recommendations:
In summary, the current evidence base on radiofrequency catheter ablation for atrial fibrillation establishes that ablation is superior to medications for maintaining sinus rhythm. Patients who require a rhythm control strategy to control symptoms and who have failed antiarrhythmic medications will benefit from catheter ablation since reduction or elimination of atrial fibrillation episodes will lead to a corresponding improvement in symptoms. The evidence also is sufficient to determine that patients with class II or III congestive heart failure and symptomatic atrial fibrillation in whom heart rate is uncontrolled have better outcomes following catheter ablation of the pulmonary veins than with AV nodal ablation and pacemaker insertion.
However, important gaps in the evidence are present. In particular, evidence on the most important clinical outcomes associated with atrial fibrillation is lacking. Therefore it is
not possible to conclude whether the majority of patients with atrial fibrillation, who do not require maintenance of sinus rhythm for symptom control, benefit from catheter ablation.
This evidence is also inadequate to evaluate adverse events. In order to accurately determine the rate for uncommon complications, such as pulmonary vein stenosis and cardiac tamponade, larger numbers of patients are required. Furthermore, there is continued evolution of the technique and precise estimates of complication rates according to variations in the procedure are not available.
Details
Project Status:
Completed
Year Published:
2008
English language abstract:
An English language summary is available
Publication Type:
Not Assigned
Country:
United States
MeSH Terms
- Blue Cross Blue Shield Insurance Plans
- Randomized Controlled Trials as Topic
- Technology Assessment, Biomedical
- Treatment Outcome
- United States
- United States Food and Drug Administration
- Atrial Fibrillation
- Catheter Ablation
- Pulmonary Veins
Contact
Organisation Name:
BlueCross BlueShield Association
Contact Address:
BlueCross BlueShield Association, Technology Evaluation Center, 225 North Michigan Ave, Chicago, Illinois, USA. Tel: 888 832 4321
Contact Name:
tec@bcbsa.com
Contact Email:
tec@bcbsa.com
Copyright:
BlueCross BlueShield Association (BCBS)
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.