Excerpt

The Agency for Healthcare Research and Quality (AHRQ) commissioned this report to review the evidence for the clinical effects and safety of radiofrequency catheter ablation (RFA) for the management of atrial fibrillation (AF). Over the past decade, RFA has rapidly evolved as a tool for managing AF in select patients. This rapid evolution has been driven by an enhanced understanding of the triggers and etiology of AF and the development of advanced catheter and imaging technologies.

After extensive discussion with AHRQ and the technical expert panel (TEP), the key questions to be addressed in this report are: 1) What is the effect of RFA on short- (6 to 12 months) and long- (>12 months) term rhythm control, rates of congestive heart failure, left atrial and ventricular size changes, rates of stroke, quality of life, avoiding anticoagulation, and readmissions for persistent, paroxysmal and long-standing persistent (chronic) atrial fibrillation? 2) What are the patient-level and intervention-level characteristics associated with RFA effect on short- and long-term rhythm control? 3) How does the effect of RFA on short- and long-term rhythm control differ among the various techniques or approaches used? 4) What are the short- and long-term complications and harms associated with RFA?

Contents

• Preface
• Acknowledgments
• Executive Summary
• 1. Introduction
  • Background
  • Key Questions
• 2. Methods
  • Topic Development
  • Search Strategy
  • Study Selection
  • Data Extraction
  • Quality Assessment
  • Rating the Body of Evidence
  • Data Synthesis
  • Metaanalysis
  • Peer Review and Public Commentary
• 3. Results
  • Key Question 1. What is the effect of RFA on short-term (6 to 12 months) and long-term (>12 months) rhythm control, rates of congestive heart failure, left atrial and ventricular size changes, rates of stroke, quality of life, avoiding anticoagulation, and readmissions for persistent, paroxysmal, and longstanding persistent (chronic) atrial fibrillation?
  • Key Question 2. What are the patient-level and intervention-level characteristics associated with RFA effect on rhythm control?
  • Key Question 3. How does the effect of RFA on short- and long-term rhythm control differ among the various techniques or approaches used?
  • Key Question 4. What are the short- and long-term complications and harms associated with RFA?
• 4. Conclusions
  • Key Question 1. What is the effect of RFA on short- (6 to 12 months) and long- (>12 months) term rhythm control, rates of congestive heart failure, left atrial and ventricular size changes, rates of stroke, quality of life, avoiding anticoagulation, and readmissions for persistent, paroxysmal and long-standing persistent (chronic) atrial fibrillation?
  • Key Question 2. What are the patient-level and intervention-level characteristics associated with RFA effect on short- and long-term rhythm control?
  • Key Question 3. How does the effect of RFA on short- and long-term rhythm control differ among the various techniques or approaches used?
  • Key Question 4. What are the short- and long-term complications and harms associated with RFA?
• 5. Discussion
  • Key Question 1: Medical Treatment Versus Radiofrequency Ablation (RFA)
  • Key Question 2: Patient- and Intervention-Level Characteristics Associated with Rhythm Control
  • Key Question 3: Approaches and Technical Issues Concerning RFA
  • Key Question 4: Adverse Events Associated with RFA
• 6. Remaining Issues and Future Research
• Abbreviations
• Appendixes
  • Appendix A Search Strategy
  • Appendix B List of Excluded Studies
  • Appendix C Evidence Tables
  • Appendix D Panel of Expert Reviewers
• References

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.¹ Contract No. 290-02-0022. Prepared by: Tufts Medical Center Evidence-based Practice Center.

Suggested citation:

Ip S, Terasawa T, Balk EM, Chung M, Alsheikh-Ali AA, Garlitski AC, Lau J. Comparative Effectiveness of Radiofrequency Catheter Ablation for Atrial Fibrillation. Comparative Effectiveness Review No. 15. (Prepared by Tufts Medical Center Evidence-based Practice Center under Contract No. 290-02-0022.) Rockville, MD: Agency for Healthcare Research and Quality. July 2009. Available at: www.effectivehealthcare.ahrq.gov/reports/final.cfm.

None of the investigators has any affiliations or financial involvement that conflicts with the material presented in this report.

This report is based on research conducted by the Tufts Medical Center Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-02-0022). The findings and conclusions in this document are those of the authors, who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

The information in this report is intended to help clinicians, employers, policymakers, and others make informed decisions about the provision of health care services. This report is intended as a reference and not as a substitute for clinical judgment.

This report may be used, in whole or in part, as the basis for the development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.

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