Long-term clinical outcomes and cost-effectiveness of catheter vs thoracoscopic surgical ablation in long-standing persistent atrial fibrillation using continuous cardiac monitoring: CASA-AF randomized controlled trial
Long-term clinical outcomes of catheter ablation (CA) compared to thoracoscopic surgical ablation (SA) to treat patients with long-standing persistent atrial fibrillation (LSPAF) are not known. The purpose of this study was to compare the long-term (36-month) clinical efficacy, quality of life, and...
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| Veröffentlicht in: | Heart rhythm 2024-09, Vol.21 (9), p.1562-1569 |
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| creator | Boyalla, Vennela Haldar, Shouvik Khan, Habib Kralj-Hans, Ines Banya, Winston Lord, Joanne Satishkumar, Anitha Bahrami, Toufan De Souza, Anthony Clague, Jonathan R. Francis, Darrel P. Hussain, Wajid Jarman, Julian W. Jones, David G. Chen, Zhong Mediratta, Neeraj Hyde, Jonathan Lewis, Michael Mohiaddin, Raad Salukhe, Tushar V. Markides, Vias McCready, James Gupta, Dhiraj Wong, Tom Yahdev, Rashmi Rahman-Halley, Shelley Wong, Joyce Opel, Aaisha Kaba, Riyaz Nyktari, Eva Cambronero-Cortinas, Esther Izgi, Cemil Fairbairn, Timothy Benton, Joanne Chester, Ruth Cunliffe, Eliane Edmondson, Lucy Gill, Matthew Griffiths, Vicky Harman, Rebecca Huggett, Catherine Keegan, Jenny Kirby, Kevin Lascelles, Karen Manivarmane, Ramasamy Munteanu, Iulia O’Brien, Karen Phyl, Tess Rahneva, Tsveta Riley, Cheryl Rogers, Paula Smith, Katherine Wage, Rick West, Cathy Yakupoglu, Yakup Yang, Guang Audraite, Audra Belchambers, Sandra Hughes, Susan Morgan, Maureen Ronayne, Christina Shaw, Rob Simkus, Paulinus Taylerson, Clive Bruce, Chloe McGregor, Andrew Thomson, Catherine Granville, Hollie Snell, Alice John, Sophia Monteiro, Christiana Augustine, Grace Sutton, Nichola |
| description | Long-term clinical outcomes of catheter ablation (CA) compared to thoracoscopic surgical ablation (SA) to treat patients with long-standing persistent atrial fibrillation (LSPAF) are not known.
The purpose of this study was to compare the long-term (36-month) clinical efficacy, quality of life, and cost-effectiveness of SA and CA in LSPAF.
Participants were followed up for 3 years using implantable loop recorders and questionnaires to assess the change in quality of life. Intention-to-treat analyses were used to report the findings.
Of the 115 patients with LSPAF treated, 104 (90.4%) completed 36-month follow-up [CA: n = 57 (95%); SA: n = 47 (85%)]. After a single procedure without antiarrhythmic drugs, 7 patients (12%) in the CA arm and 5 (11%) in the SA arm [hazard ratio 1.22; 95% confidence interval (CI) 0.81–1.83; P = .41] were free from atrial fibrillation/tachycardia (AF/AT) ≥30 seconds at 36 months. Thirty-three patients (58%) in the CA arm and 26 (55%) in the SA arm (hazard ratio 1.04; 95% CI 0.57–1.88; P = .91) had their AF/AT burden reduced by ≥75%. The overall impact on health-related quality of life was similar, with mean quality-adjusted life year estimates of 2.45 (95% CI 2.31–2.59) for CA and 2.32 (95% CI 2.13–2.52) for SA. Estimated costs were higher for SA (mean £24,682; 95% CI £21,746–£27,618) than for CA (mean £18,002; 95% CI £15,422–£20,581).
In symptomatic LSPAF, CA and SA were equally effective at achieving arrhythmia outcomes (freedom from AF/AT ≥30 seconds and ≥75% burden reduction) after a single procedure without antiarrhythmic drugs. However, SA is significantly more costly than CA. |
| doi_str_mv | 10.1016/j.hrthm.2024.05.022 |
| format | Article |
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The purpose of this study was to compare the long-term (36-month) clinical efficacy, quality of life, and cost-effectiveness of SA and CA in LSPAF.
Participants were followed up for 3 years using implantable loop recorders and questionnaires to assess the change in quality of life. Intention-to-treat analyses were used to report the findings.
Of the 115 patients with LSPAF treated, 104 (90.4%) completed 36-month follow-up [CA: n = 57 (95%); SA: n = 47 (85%)]. After a single procedure without antiarrhythmic drugs, 7 patients (12%) in the CA arm and 5 (11%) in the SA arm [hazard ratio 1.22; 95% confidence interval (CI) 0.81–1.83; P = .41] were free from atrial fibrillation/tachycardia (AF/AT) ≥30 seconds at 36 months. Thirty-three patients (58%) in the CA arm and 26 (55%) in the SA arm (hazard ratio 1.04; 95% CI 0.57–1.88; P = .91) had their AF/AT burden reduced by ≥75%. The overall impact on health-related quality of life was similar, with mean quality-adjusted life year estimates of 2.45 (95% CI 2.31–2.59) for CA and 2.32 (95% CI 2.13–2.52) for SA. Estimated costs were higher for SA (mean £24,682; 95% CI £21,746–£27,618) than for CA (mean £18,002; 95% CI £15,422–£20,581).
In symptomatic LSPAF, CA and SA were equally effective at achieving arrhythmia outcomes (freedom from AF/AT ≥30 seconds and ≥75% burden reduction) after a single procedure without antiarrhythmic drugs. However, SA is significantly more costly than CA.</description><identifier>ISSN: 1547-5271</identifier><identifier>ISSN: 1556-3871</identifier><identifier>EISSN: 1556-3871</identifier><identifier>DOI: 10.1016/j.hrthm.2024.05.022</identifier><identifier>PMID: 38763376</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Atrial Fibrillation - economics ; Atrial Fibrillation - physiopathology ; Atrial Fibrillation - surgery ; Catheter ablation ; Catheter Ablation - economics ; Catheter Ablation - methods ; Continuous cardiac monitoring ; Cost-Benefit Analysis ; Electrocardiography, Ambulatory - economics ; Electrocardiography, Ambulatory - methods ; Female ; Follow-Up Studies ; Humans ; Long-standing persistent atrial fibrillation ; Long-term follow-up ; Male ; Middle Aged ; Quality of Life ; Randomized clinical trial ; Surgical ablation ; Thoracoscopy - economics ; Thoracoscopy - methods ; Time Factors ; Treatment Outcome</subject><ispartof>Heart rhythm, 2024-09, Vol.21 (9), p.1562-1569</ispartof><rights>2024</rights><rights>Crown Copyright © 2024. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c1546-2a812e00cb3623a894665228b0787707052e5d0e83b0d5196bba498cfb12f0ab3</cites><orcidid>0000-0001-7401-6281</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1547527124025645$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38763376$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Boyalla, Vennela</creatorcontrib><creatorcontrib>Haldar, Shouvik</creatorcontrib><creatorcontrib>Khan, Habib</creatorcontrib><creatorcontrib>Kralj-Hans, Ines</creatorcontrib><creatorcontrib>Banya, Winston</creatorcontrib><creatorcontrib>Lord, Joanne</creatorcontrib><creatorcontrib>Satishkumar, Anitha</creatorcontrib><creatorcontrib>Bahrami, Toufan</creatorcontrib><creatorcontrib>De Souza, Anthony</creatorcontrib><creatorcontrib>Clague, Jonathan R.</creatorcontrib><creatorcontrib>Francis, Darrel P.</creatorcontrib><creatorcontrib>Hussain, Wajid</creatorcontrib><creatorcontrib>Jarman, Julian W.</creatorcontrib><creatorcontrib>Jones, David G.</creatorcontrib><creatorcontrib>Chen, Zhong</creatorcontrib><creatorcontrib>Mediratta, Neeraj</creatorcontrib><creatorcontrib>Hyde, Jonathan</creatorcontrib><creatorcontrib>Lewis, Michael</creatorcontrib><creatorcontrib>Mohiaddin, Raad</creatorcontrib><creatorcontrib>Salukhe, Tushar V.</creatorcontrib><creatorcontrib>Markides, Vias</creatorcontrib><creatorcontrib>McCready, James</creatorcontrib><creatorcontrib>Gupta, Dhiraj</creatorcontrib><creatorcontrib>Wong, Tom</creatorcontrib><creatorcontrib>Yahdev, Rashmi</creatorcontrib><creatorcontrib>Rahman-Halley, Shelley</creatorcontrib><creatorcontrib>Wong, Joyce</creatorcontrib><creatorcontrib>Opel, Aaisha</creatorcontrib><creatorcontrib>Kaba, Riyaz</creatorcontrib><creatorcontrib>Nyktari, Eva</creatorcontrib><creatorcontrib>Cambronero-Cortinas, Esther</creatorcontrib><creatorcontrib>Izgi, Cemil</creatorcontrib><creatorcontrib>Fairbairn, Timothy</creatorcontrib><creatorcontrib>Benton, Joanne</creatorcontrib><creatorcontrib>Chester, Ruth</creatorcontrib><creatorcontrib>Cunliffe, Eliane</creatorcontrib><creatorcontrib>Edmondson, Lucy</creatorcontrib><creatorcontrib>Gill, Matthew</creatorcontrib><creatorcontrib>Griffiths, Vicky</creatorcontrib><creatorcontrib>Harman, Rebecca</creatorcontrib><creatorcontrib>Huggett, Catherine</creatorcontrib><creatorcontrib>Keegan, Jenny</creatorcontrib><creatorcontrib>Kirby, Kevin</creatorcontrib><creatorcontrib>Lascelles, Karen</creatorcontrib><creatorcontrib>Manivarmane, Ramasamy</creatorcontrib><creatorcontrib>Munteanu, Iulia</creatorcontrib><creatorcontrib>O’Brien, Karen</creatorcontrib><creatorcontrib>Phyl, Tess</creatorcontrib><creatorcontrib>Rahneva, Tsveta</creatorcontrib><creatorcontrib>Riley, Cheryl</creatorcontrib><creatorcontrib>Rogers, Paula</creatorcontrib><creatorcontrib>Smith, Katherine</creatorcontrib><creatorcontrib>Wage, Rick</creatorcontrib><creatorcontrib>West, Cathy</creatorcontrib><creatorcontrib>Yakupoglu, Yakup</creatorcontrib><creatorcontrib>Yang, Guang</creatorcontrib><creatorcontrib>Audraite, Audra</creatorcontrib><creatorcontrib>Belchambers, Sandra</creatorcontrib><creatorcontrib>Hughes, Susan</creatorcontrib><creatorcontrib>Morgan, Maureen</creatorcontrib><creatorcontrib>Ronayne, Christina</creatorcontrib><creatorcontrib>Shaw, Rob</creatorcontrib><creatorcontrib>Simkus, Paulinus</creatorcontrib><creatorcontrib>Taylerson, Clive</creatorcontrib><creatorcontrib>Bruce, Chloe</creatorcontrib><creatorcontrib>McGregor, Andrew</creatorcontrib><creatorcontrib>Thomson, Catherine</creatorcontrib><creatorcontrib>Granville, Hollie</creatorcontrib><creatorcontrib>Snell, Alice</creatorcontrib><creatorcontrib>John, Sophia</creatorcontrib><creatorcontrib>Monteiro, Christiana</creatorcontrib><creatorcontrib>Augustine, Grace</creatorcontrib><creatorcontrib>Sutton, Nichola</creatorcontrib><creatorcontrib>CASA-AF Investigators</creatorcontrib><title>Long-term clinical outcomes and cost-effectiveness of catheter vs thoracoscopic surgical ablation in long-standing persistent atrial fibrillation using continuous cardiac monitoring: CASA-AF randomized controlled trial</title><title>Heart rhythm</title><addtitle>Heart Rhythm</addtitle><description>Long-term clinical outcomes of catheter ablation (CA) compared to thoracoscopic surgical ablation (SA) to treat patients with long-standing persistent atrial fibrillation (LSPAF) are not known.
The purpose of this study was to compare the long-term (36-month) clinical efficacy, quality of life, and cost-effectiveness of SA and CA in LSPAF.
Participants were followed up for 3 years using implantable loop recorders and questionnaires to assess the change in quality of life. Intention-to-treat analyses were used to report the findings.
Of the 115 patients with LSPAF treated, 104 (90.4%) completed 36-month follow-up [CA: n = 57 (95%); SA: n = 47 (85%)]. After a single procedure without antiarrhythmic drugs, 7 patients (12%) in the CA arm and 5 (11%) in the SA arm [hazard ratio 1.22; 95% confidence interval (CI) 0.81–1.83; P = .41] were free from atrial fibrillation/tachycardia (AF/AT) ≥30 seconds at 36 months. Thirty-three patients (58%) in the CA arm and 26 (55%) in the SA arm (hazard ratio 1.04; 95% CI 0.57–1.88; P = .91) had their AF/AT burden reduced by ≥75%. The overall impact on health-related quality of life was similar, with mean quality-adjusted life year estimates of 2.45 (95% CI 2.31–2.59) for CA and 2.32 (95% CI 2.13–2.52) for SA. Estimated costs were higher for SA (mean £24,682; 95% CI £21,746–£27,618) than for CA (mean £18,002; 95% CI £15,422–£20,581).
In symptomatic LSPAF, CA and SA were equally effective at achieving arrhythmia outcomes (freedom from AF/AT ≥30 seconds and ≥75% burden reduction) after a single procedure without antiarrhythmic drugs. However, SA is significantly more costly than CA.</description><subject>Aged</subject><subject>Atrial Fibrillation - economics</subject><subject>Atrial Fibrillation - physiopathology</subject><subject>Atrial Fibrillation - surgery</subject><subject>Catheter ablation</subject><subject>Catheter Ablation - economics</subject><subject>Catheter Ablation - methods</subject><subject>Continuous cardiac monitoring</subject><subject>Cost-Benefit Analysis</subject><subject>Electrocardiography, Ambulatory - economics</subject><subject>Electrocardiography, Ambulatory - methods</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Long-standing persistent atrial fibrillation</subject><subject>Long-term follow-up</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Quality of Life</subject><subject>Randomized clinical trial</subject><subject>Surgical ablation</subject><subject>Thoracoscopy - economics</subject><subject>Thoracoscopy - 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CASA-AF randomized controlled trial</title><author>Boyalla, Vennela ; Haldar, Shouvik ; Khan, Habib ; Kralj-Hans, Ines ; Banya, Winston ; Lord, Joanne ; Satishkumar, Anitha ; Bahrami, Toufan ; De Souza, Anthony ; Clague, Jonathan R. ; Francis, Darrel P. ; Hussain, Wajid ; Jarman, Julian W. ; Jones, David G. ; Chen, Zhong ; Mediratta, Neeraj ; Hyde, Jonathan ; Lewis, Michael ; Mohiaddin, Raad ; Salukhe, Tushar V. ; Markides, Vias ; McCready, James ; Gupta, Dhiraj ; Wong, Tom ; Yahdev, Rashmi ; Rahman-Halley, Shelley ; Wong, Joyce ; Opel, Aaisha ; Kaba, Riyaz ; Nyktari, Eva ; Cambronero-Cortinas, Esther ; Izgi, Cemil ; Fairbairn, Timothy ; Benton, Joanne ; Chester, Ruth ; Cunliffe, Eliane ; Edmondson, Lucy ; Gill, Matthew ; Griffiths, Vicky ; Harman, Rebecca ; Huggett, Catherine ; Keegan, Jenny ; Kirby, Kevin ; Lascelles, Karen ; Manivarmane, Ramasamy ; Munteanu, Iulia ; O’Brien, Karen ; Phyl, Tess ; Rahneva, Tsveta ; Riley, Cheryl ; Rogers, Paula ; Smith, Katherine ; Wage, Rick ; West, Cathy ; Yakupoglu, Yakup ; Yang, Guang ; Audraite, Audra ; Belchambers, Sandra ; Hughes, Susan ; Morgan, Maureen ; Ronayne, Christina ; Shaw, Rob ; Simkus, Paulinus ; Taylerson, Clive ; Bruce, Chloe ; McGregor, Andrew ; Thomson, Catherine ; Granville, Hollie ; Snell, Alice ; John, Sophia ; Monteiro, Christiana ; Augustine, Grace ; Sutton, Nichola</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c1546-2a812e00cb3623a894665228b0787707052e5d0e83b0d5196bba498cfb12f0ab3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Aged</topic><topic>Atrial Fibrillation - economics</topic><topic>Atrial Fibrillation - physiopathology</topic><topic>Atrial Fibrillation - surgery</topic><topic>Catheter ablation</topic><topic>Catheter Ablation - economics</topic><topic>Catheter Ablation - methods</topic><topic>Continuous cardiac monitoring</topic><topic>Cost-Benefit Analysis</topic><topic>Electrocardiography, Ambulatory - economics</topic><topic>Electrocardiography, Ambulatory - methods</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Long-standing persistent atrial fibrillation</topic><topic>Long-term follow-up</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Quality of Life</topic><topic>Randomized clinical trial</topic><topic>Surgical ablation</topic><topic>Thoracoscopy - economics</topic><topic>Thoracoscopy - methods</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Boyalla, Vennela</creatorcontrib><creatorcontrib>Haldar, Shouvik</creatorcontrib><creatorcontrib>Khan, Habib</creatorcontrib><creatorcontrib>Kralj-Hans, Ines</creatorcontrib><creatorcontrib>Banya, Winston</creatorcontrib><creatorcontrib>Lord, Joanne</creatorcontrib><creatorcontrib>Satishkumar, Anitha</creatorcontrib><creatorcontrib>Bahrami, Toufan</creatorcontrib><creatorcontrib>De Souza, Anthony</creatorcontrib><creatorcontrib>Clague, Jonathan R.</creatorcontrib><creatorcontrib>Francis, Darrel P.</creatorcontrib><creatorcontrib>Hussain, Wajid</creatorcontrib><creatorcontrib>Jarman, Julian W.</creatorcontrib><creatorcontrib>Jones, David G.</creatorcontrib><creatorcontrib>Chen, Zhong</creatorcontrib><creatorcontrib>Mediratta, Neeraj</creatorcontrib><creatorcontrib>Hyde, Jonathan</creatorcontrib><creatorcontrib>Lewis, Michael</creatorcontrib><creatorcontrib>Mohiaddin, Raad</creatorcontrib><creatorcontrib>Salukhe, Tushar V.</creatorcontrib><creatorcontrib>Markides, Vias</creatorcontrib><creatorcontrib>McCready, James</creatorcontrib><creatorcontrib>Gupta, Dhiraj</creatorcontrib><creatorcontrib>Wong, Tom</creatorcontrib><creatorcontrib>Yahdev, Rashmi</creatorcontrib><creatorcontrib>Rahman-Halley, Shelley</creatorcontrib><creatorcontrib>Wong, Joyce</creatorcontrib><creatorcontrib>Opel, Aaisha</creatorcontrib><creatorcontrib>Kaba, Riyaz</creatorcontrib><creatorcontrib>Nyktari, Eva</creatorcontrib><creatorcontrib>Cambronero-Cortinas, Esther</creatorcontrib><creatorcontrib>Izgi, Cemil</creatorcontrib><creatorcontrib>Fairbairn, Timothy</creatorcontrib><creatorcontrib>Benton, Joanne</creatorcontrib><creatorcontrib>Chester, Ruth</creatorcontrib><creatorcontrib>Cunliffe, Eliane</creatorcontrib><creatorcontrib>Edmondson, Lucy</creatorcontrib><creatorcontrib>Gill, Matthew</creatorcontrib><creatorcontrib>Griffiths, Vicky</creatorcontrib><creatorcontrib>Harman, Rebecca</creatorcontrib><creatorcontrib>Huggett, Catherine</creatorcontrib><creatorcontrib>Keegan, Jenny</creatorcontrib><creatorcontrib>Kirby, Kevin</creatorcontrib><creatorcontrib>Lascelles, Karen</creatorcontrib><creatorcontrib>Manivarmane, Ramasamy</creatorcontrib><creatorcontrib>Munteanu, Iulia</creatorcontrib><creatorcontrib>O’Brien, Karen</creatorcontrib><creatorcontrib>Phyl, Tess</creatorcontrib><creatorcontrib>Rahneva, Tsveta</creatorcontrib><creatorcontrib>Riley, Cheryl</creatorcontrib><creatorcontrib>Rogers, Paula</creatorcontrib><creatorcontrib>Smith, Katherine</creatorcontrib><creatorcontrib>Wage, Rick</creatorcontrib><creatorcontrib>West, Cathy</creatorcontrib><creatorcontrib>Yakupoglu, Yakup</creatorcontrib><creatorcontrib>Yang, Guang</creatorcontrib><creatorcontrib>Audraite, Audra</creatorcontrib><creatorcontrib>Belchambers, Sandra</creatorcontrib><creatorcontrib>Hughes, Susan</creatorcontrib><creatorcontrib>Morgan, Maureen</creatorcontrib><creatorcontrib>Ronayne, Christina</creatorcontrib><creatorcontrib>Shaw, Rob</creatorcontrib><creatorcontrib>Simkus, Paulinus</creatorcontrib><creatorcontrib>Taylerson, Clive</creatorcontrib><creatorcontrib>Bruce, Chloe</creatorcontrib><creatorcontrib>McGregor, Andrew</creatorcontrib><creatorcontrib>Thomson, Catherine</creatorcontrib><creatorcontrib>Granville, Hollie</creatorcontrib><creatorcontrib>Snell, Alice</creatorcontrib><creatorcontrib>John, Sophia</creatorcontrib><creatorcontrib>Monteiro, Christiana</creatorcontrib><creatorcontrib>Augustine, Grace</creatorcontrib><creatorcontrib>Sutton, Nichola</creatorcontrib><creatorcontrib>CASA-AF Investigators</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Heart rhythm</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Boyalla, Vennela</au><au>Haldar, Shouvik</au><au>Khan, Habib</au><au>Kralj-Hans, Ines</au><au>Banya, Winston</au><au>Lord, Joanne</au><au>Satishkumar, Anitha</au><au>Bahrami, Toufan</au><au>De Souza, Anthony</au><au>Clague, Jonathan R.</au><au>Francis, Darrel P.</au><au>Hussain, Wajid</au><au>Jarman, Julian W.</au><au>Jones, David G.</au><au>Chen, Zhong</au><au>Mediratta, Neeraj</au><au>Hyde, Jonathan</au><au>Lewis, Michael</au><au>Mohiaddin, Raad</au><au>Salukhe, Tushar V.</au><au>Markides, Vias</au><au>McCready, James</au><au>Gupta, Dhiraj</au><au>Wong, Tom</au><au>Yahdev, Rashmi</au><au>Rahman-Halley, Shelley</au><au>Wong, Joyce</au><au>Opel, Aaisha</au><au>Kaba, Riyaz</au><au>Nyktari, Eva</au><au>Cambronero-Cortinas, Esther</au><au>Izgi, Cemil</au><au>Fairbairn, Timothy</au><au>Benton, Joanne</au><au>Chester, Ruth</au><au>Cunliffe, Eliane</au><au>Edmondson, Lucy</au><au>Gill, Matthew</au><au>Griffiths, Vicky</au><au>Harman, Rebecca</au><au>Huggett, Catherine</au><au>Keegan, Jenny</au><au>Kirby, Kevin</au><au>Lascelles, Karen</au><au>Manivarmane, Ramasamy</au><au>Munteanu, Iulia</au><au>O’Brien, Karen</au><au>Phyl, Tess</au><au>Rahneva, Tsveta</au><au>Riley, Cheryl</au><au>Rogers, Paula</au><au>Smith, Katherine</au><au>Wage, Rick</au><au>West, Cathy</au><au>Yakupoglu, Yakup</au><au>Yang, Guang</au><au>Audraite, Audra</au><au>Belchambers, Sandra</au><au>Hughes, Susan</au><au>Morgan, Maureen</au><au>Ronayne, Christina</au><au>Shaw, Rob</au><au>Simkus, Paulinus</au><au>Taylerson, Clive</au><au>Bruce, Chloe</au><au>McGregor, Andrew</au><au>Thomson, Catherine</au><au>Granville, Hollie</au><au>Snell, Alice</au><au>John, Sophia</au><au>Monteiro, Christiana</au><au>Augustine, Grace</au><au>Sutton, Nichola</au><aucorp>CASA-AF Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Long-term clinical outcomes and cost-effectiveness of catheter vs thoracoscopic surgical ablation in long-standing persistent atrial fibrillation using continuous cardiac monitoring: CASA-AF randomized controlled trial</atitle><jtitle>Heart rhythm</jtitle><addtitle>Heart Rhythm</addtitle><date>2024-09</date><risdate>2024</risdate><volume>21</volume><issue>9</issue><spage>1562</spage><epage>1569</epage><pages>1562-1569</pages><issn>1547-5271</issn><issn>1556-3871</issn><eissn>1556-3871</eissn><abstract>Long-term clinical outcomes of catheter ablation (CA) compared to thoracoscopic surgical ablation (SA) to treat patients with long-standing persistent atrial fibrillation (LSPAF) are not known.
The purpose of this study was to compare the long-term (36-month) clinical efficacy, quality of life, and cost-effectiveness of SA and CA in LSPAF.
Participants were followed up for 3 years using implantable loop recorders and questionnaires to assess the change in quality of life. Intention-to-treat analyses were used to report the findings.
Of the 115 patients with LSPAF treated, 104 (90.4%) completed 36-month follow-up [CA: n = 57 (95%); SA: n = 47 (85%)]. After a single procedure without antiarrhythmic drugs, 7 patients (12%) in the CA arm and 5 (11%) in the SA arm [hazard ratio 1.22; 95% confidence interval (CI) 0.81–1.83; P = .41] were free from atrial fibrillation/tachycardia (AF/AT) ≥30 seconds at 36 months. Thirty-three patients (58%) in the CA arm and 26 (55%) in the SA arm (hazard ratio 1.04; 95% CI 0.57–1.88; P = .91) had their AF/AT burden reduced by ≥75%. The overall impact on health-related quality of life was similar, with mean quality-adjusted life year estimates of 2.45 (95% CI 2.31–2.59) for CA and 2.32 (95% CI 2.13–2.52) for SA. Estimated costs were higher for SA (mean £24,682; 95% CI £21,746–£27,618) than for CA (mean £18,002; 95% CI £15,422–£20,581).
In symptomatic LSPAF, CA and SA were equally effective at achieving arrhythmia outcomes (freedom from AF/AT ≥30 seconds and ≥75% burden reduction) after a single procedure without antiarrhythmic drugs. However, SA is significantly more costly than CA.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>38763376</pmid><doi>10.1016/j.hrthm.2024.05.022</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0001-7401-6281</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1547-5271 |
| ispartof | Heart rhythm, 2024-09, Vol.21 (9), p.1562-1569 |
| issn | 1547-5271 1556-3871 1556-3871 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_3057074120 |
| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Aged Atrial Fibrillation - economics Atrial Fibrillation - physiopathology Atrial Fibrillation - surgery Catheter ablation Catheter Ablation - economics Catheter Ablation - methods Continuous cardiac monitoring Cost-Benefit Analysis Electrocardiography, Ambulatory - economics Electrocardiography, Ambulatory - methods Female Follow-Up Studies Humans Long-standing persistent atrial fibrillation Long-term follow-up Male Middle Aged Quality of Life Randomized clinical trial Surgical ablation Thoracoscopy - economics Thoracoscopy - methods Time Factors Treatment Outcome |
| title | Long-term clinical outcomes and cost-effectiveness of catheter vs thoracoscopic surgical ablation in long-standing persistent atrial fibrillation using continuous cardiac monitoring: CASA-AF randomized controlled trial |
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