COST COMPARISON OF RADIOFREQUENCY MODIFICATION AND ABLATION OF THE ATRIOVENTRICULAR JUNCTION IN PATIENTS WITH CHRONIC ATRIAL-FIBRILLATION

Background Because it is not clear which technique is less expensive, the purpose of this study was to compare the cost of radiofrequency mo dification and ablation of the atrioventricular (AV) node in drug-refr actory patients with atrial fibrillation and an uncontrolled ventricul ar rate. Methods and Results Tile initial nominal charges for a succes sful procedure were compared in 10 patients with chronic atrial fibril lation who underwent modification of the AV node ($13 109+/-2002) and 14 similar patients who underwent ablation and pacemaker implantation ($28 302+/-2023 P<.001). On the basis of the long-term follow-up of pa tients who underwent each procedure, it was assumed that 31% of patien ts selected for the modification procedure would require a permanent p acemaker for inadvertent AV block or because of AV nodal ablation afte r a failed modification procedure and that the recurrence rate after A V node ablation would be 3%. The annual charges during follow-up were predicted and adjusted for recurrences and the need for additional pro cedures. The adjusted total charges at 1 year of follow-up were signif icantly lower for the modification procedure ($19 389+/-2002) than for the ablation procedure ($28 485+/-2023, P<.001). After 10 years of fo llow-up, the cumulative, adjusted charges for modification were $20 01 6 (42%) less than for ablation. Conclusions The initial charges genera ted by AV node modification are significantly lower than for AV node a blation in patients with chronic atrial fibrillation. Even when adjust ed for higher failure and recurrence rates, the modification procedure retains a major cost advantage over ablation during long-term follow- up.