Selectively ablating patients with atrial fibrillation reduces costs, according to a substudy of the DECAAF trial presented Nov. 18 at the American Heart Association scientific session in Dallas.

DECAAF (Delayed-Enhancement MRI Determinant of Successful Radiofrequency Catheter Ablation of Atrial Fibrillation) is a prospective multicenter observational study designed to assess the relationship between the extent of pre-ablation fibrosis and recurrence post-ablation in patients with atrial fibrillation. The assessment was based on MRI scans and preprocedural and follow-up data.

All patients received delayed-enhancement MRI within 30 days before the ablation procedure to quantify the degree of atrial structural remodeling or fibrosis, followed by scans at three, six and 12 months to quantify ablation-related scar formation.

Joseph Biskupiak, PhD, MBA, and colleagues at the University of Utah in Salt Lake City compared costs for selective ablation and ablation of all patients based on data from 261 DECAAF participants. The participants were categorized by Utah Stage: 19 percent were Stage I; 41 percent Stage II; 31 percent Utah Stage III; and 9 percent Stage IV. The staging was based on the degree of atrial structural remodeling detected through imaging.

The proportion of patients with post-ablation recurrence by Utah Stage I-IV was 17 percent, 31 percent, 46 percent and 59 percent, respectively. In the selective ablation group, Stage I and II patients were treated with ablation and Stage III and IV patients with medical management.

Costs included the ablation procedure, recurrence, anticoagulation therapy and annual atrial fibrillation care. Biskupiak et al found that mean total costs per patient were lower in the selective ablation group, at $24,384 versus $27,297, partly due to a higher atrial fibrillation recurrence rate and annual treatment costs in the all ablation group.

In a sensitivity analysis, MRI costs of up to $5,000 offered economic benefit for selective ablation versus ablation of all patients. Based on the data, selective ablation that identified candidates by their degree of structural remodeling provided a cost savings of $2,910 per patient compared with the current standard of care.