Draft report: Jury’s still out on catheter ablation

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The official position for catheter ablation as a treatment for atrial fibrillation in a draft technology assessment report for the Agency for Healthcare Research and Quality (AHRQ) is “can’t tell yet.” The draft report is open for review through Dec. 8.

AHRQ commissioned the Pacific Northwest Evidence-based Practice Center to review the literature on the efficacy and safety of catheter ablation in Medicare beneficiaries with atrial fibrillation. The reviewers assessed 34 trials and observational studies that compared radiofrequency and cryoballoon ablation with medical therapy in patients with atrial fibrillation.

“Because there is increasing use of catheter ablation to treat AF [atrial fibrillation] patients in the Medicare population as well as uncertainty regarding the efficacy and harms of this procedure in this population in particular, … the Centers for Medicare and Medicaid (CMS) has partnered with AHRQ to commission this independent systematic review to evaluate the current state of comparative evidence to help inform clinical practice and policy and to provide insight into research needs and general approaches for addressing identified evidence gaps.”

The report concludes that the studies as a whole fail to provide sufficient evidence of the benefits and harms of catheter ablation in Medicare patients to make a conclusion. They authors characterized the strength of evidence as low for patients with paroxysmal atrial fibrillation. They found no difference between radiofrequency ablation and medical therapy for all-cause-mortality and MI risk after 30 days. They termed the evidence for stroke, congestive heart failure and health-related quality of life as insufficient.

Radiofrequency ablation fared better for preventing recurrences for all types of atrial fibrillation, with the evidence for its superiority over medical therapy considered of moderate strength, and on par with medical therapy for 30-day mortality and stroke.

They concluded that the evidence for cryoablation, compared with either medical therapy or with radiofrequency ablation, to be insufficient to draw conclusions on efficacy or safety.

The draft report is available here.