(diary, Holter) Digoxin 2.3±3.1, 1.9±2.9 Propranolol 1.5±2.3 ,0.2±0.6 Verapamil 2.9±5.7 ,0.6 ±1.6 Duration(min) (diary, Holter) Digoxin 75±164, 47±157 Propranolol 60±112 ,1±1 Verapamil 56±148 ,1±1 Small series of pts. Unclear mechanism of PSVT (authors speculate all pts w/ AVRNT or oral rehydration therapy w/ concealed conduction. 1986 (25) Efficacy of esmolol in of PSVT 71 study Esmolol (n=36) Placebo (n=35) “SVT” (HR>120) Note: AVNRT in 18% of subjects VHD, AV block, SSS, significant electrolyte abnormality, precluding treatment w/ beta blockade, bronchial asthma, ventricular arrhythmias requiring drug therapy, cardiogenic shock, CHF (NYHA III-IV), renal or hepatic dysfunction, drug or alcohol abuse, on other blockers or calcium channel blockers w/in two half-lives of study entry Therapeutic response: ≥20% reduction in HR, HR<100 bpm, or conversion to NSR. Therapeutic response to esmolol during the initial treatment period (72%) similar when esmolol was given as a second agent 4 pts (6%) converted to NSR In the 80% therapeutic response lost Hypotension which occurred in12% on esmolol, 2% w/ placebo. N/A p=NS Rapid onset and short of action of esmolol offer safe, effective therapy for acute treatment of pts w/ PSVT. Low numbers of pts w/ AVNRT. blind, t r
w/in 30 min following of esmolol infusion Henthorn 1991 (26) for of PSVT (≥2 34 8-wk (after four episodes of PSVT or end of period) Flecainide (n=34) Placebo (n=34) PSVT Syncope, angina, or transient cerebral events during PSVT, second or third degree AV block or had CHF (NYHA Freedom from symptomatic PSVT at 60 d: 79% events vs. 15% (p<0.001) Flecainide slowed symptomatic PSVT HR to 143±12 bpm from 178 ±12 on placebo in 7 pts who had events in the placebo and flecainide treatment phases (p<0.02) Significantly more side effects w/ flecainide (p<0.05) Flecainide vs. placebo: Recurrence: 8/34 vs. 29/34 (p<0.001). Median time to first event: 55 vs. 11 (p<0.001) Median interval between episodes >55 vs. 12 d (p<0.001) N/A Despite participation of 19 medical centers, only 34 pts completed entire protocol and provided analyzable data. All pts tolerated flecainide, limiting monitoring does not permit assessment of 6/34 w/ AVNRT, confirmed by EP study, and 18/34 w/ unknown mechanism. (27) efficacy of in patents w/ 42 Flecainide given in ascending order (2550100150 mg bid) PSVT (n=14, Group Placebo inserted at random (alternating w/ flecainide) at 30 d intervals PSVT, PAF, or paroxysmal atrial flutter Syncope, angina, or transient cerebral events during PSVT, second or third degree AV block or had CHF (NYHA . Among 14 pts in Group 1 (PSVT) who qualified for efficacy analysis, 4 (29%) had no tachycardia while taking Noncardiac adverse experiences were leading cause of premature study discontinuation during N/A N/A Small sample size, short treatment period. Pritchett proarrhythmia )
PSVT, PAF, atrial flutter 1) PAF or parosysmal atrial flutter (n=28, Group 2) placebo. Number w/ no tachycardia increased w/ progressively larger flecainide doses; w/ the 150 mg twice daily dose, 12 (86%) of 14 pts had no tachycardia (p<0.01 for overall differences among all treatments). flecainide treatment periods (5 pts in Group 1 and 6 pts in Group 2). 1991 (28) Oral to prevent PSVT phase, w/ each period lasting up to 60 d. 23 Propafenone (n=23) Placebo (n=23) PSVT (n=14) PAF (n=9) Angina during tachycardia, pulmonary edema, neurologic sxs. PAF w/ WPW, on AADs Compared w/ placebo, propafenone caused an increase in time to first recurrence of arrhythmia (p=0.004) PSVT: p=0.03 PAF: p=0.06 . Cardiac AEs occurred only in pts w/ PAF (9/11): 2 w/ prolonged episode of AF, 1 w/ atrial flutter w/ a mean ventricular rate of 263 bpm recorded using the telephone monitor. HR during recurrences, and not statistically different between propafenone and placebo N/A Propafenone efficacious in treating PSVT and PAF. Major limitation in not knowing how many pts had AVNRT. . 1994 (29) efficacy of (≥6 49 PSVT (n=21) PAF (n=28) Placebo Pts enrolled from 3 prior studies evaluating short-term flecainide efficacy Syncope, angina, or transient cerebral events during PSVT, second or third degree AV block or had CHF (NYHA -Number of pts w/o attacks -Time to first attack -Interval No pt experienced proarrhythmia, MI, or died during chronic efficacy study. N/A N/A Supports flecainide for chronic therapy of PSVT. d, blind, n
2000 (60) effectiveness of RFA w/ medical management of PSVT pts w/ 4.6 unscheduled visits/y for arrhythmia while on long-term drug therapy Estimated population: AVNRT: 65% AVRT w/ concealed AP: 30% Efficacy estimates: AVNRT: 97% AVRT w/ concealed AP: 93% Recurrence estimates: AVNRT: 5% AVRT w/ concealed AP: 8% Drug efficacy: 60% Outcomes: costs (office visit, annual drug rx, EP study, RFA, PPM, PPM replacement) QALY Life-years Marginal cost-effectiveness ratios PSVT, RFA most effective and least expensive option RFA reduced lifetime medical expenditures by $27,940 compared w/ long-term pharmacologic therapy Lifetime costs: RFA: $61,880 Long-term drug rx: $89,820 Episodic drug rx: $143,530 RFA improved life expectancy by 3.10 QALYs. reduces costs when treating highly symptomatic pts. Effects in less symptomatic not studies Scheinman MM 2000 (61) Prospective cohort study (NASPE registry) 3,357 Ablation of AVNRT, AP, AVJ, atrial flutter, AT, IST, VT, idiopathic VT AVNRT (n=1,197 [35.6%) AVJ (n=646) AP (n=654) AT (n=216) Atrial flutter (n=447) IST (n=40) Efficacy and safety of RFA w/ long-term f/u. AVNRT Success: 96.1% Complications: 2% AVJ: Success: 96% Complications: 25 pts Recurrence:3.5% AP: Success: 94-96% Complications: 31 pts total Recurrence: 4.6% AT: Success: 51-79% Complications:5 total Recurrence:15.2% Atrial flutter: Success: 86% Complications:12 pts Recurrence:14.7% IST: Success: 71% Large series reporting success of RFA, and stratification by age group confirms safety and efficacy in elderly pts, as well as by type of facility (teaching vs. community). adjusted
metoprolol gase pH and PaCO2 were unaltered; mean PaO2 increased by 12.2 +/- 5.8 torr (p<0.05) B indicates blood pressure; bpm, beats per minute; MAT, multifocal atrial tachycardia; N/A, not applicable; NSR, normal sinus rhythm; PaCO2, partial pressure of carbon dioxide; pt, patient; and w/, with. Data Supplement 9. Randomized Trials Comparing Atrioventricular Nodal Re-Entrant Tachycardia – Section 5 Study Name, Author, Year Aim of Study Study Type (Size, N) Study Intervention Group (n) Study Comparator Group (n) Pt Population Endpoints P Values, OR: HR: RR: & 95% CI: Study Limitations & Adverse Events Inclusion Criteria Exclusion Criteria Primary Endpoint (efficacy) and Results Safety Endpoint and Results Secondary Endpoint and Results Pharmacological Therapy Waxman HL 1981 (112) of IV 50 Group 1 (n=20) w/ AF or flutter Group 2 (n=30) PSVT (AVNRT in 8 pts), N/A PSVT w/ AF, atrial flutter, PSVT N/A Control of ventricular response in group 1, restoration of sinus rhythm in group 2 In Group 1 low-dose verapamil (0.075 mg/kg body weight) decreased the mean ventricular rate from 146 to 114 bpm (p<0.01) compared to a decrease of 145 to 132 bpm (p<0.01) after placebo. In Group 2, 14/29 pts converted to sinus rhythm after low-dose verapamil, N/A N/A N/A Verapamil results in a clinically significant slowing of the ventricular response in AF or atrial flutter and is superior to placebo for conversion of PSVT to sinus rhythm Effective
0.2±0.6 Verapamil 2.9±5.7, 0.6±1.6 Duration (min) (diary, Holter) Digoxin 75±164, 47±157 Propranolol 60±112, 1±1 Verapamil 56±148, 1±1 PSVT (authors speculate all pts w/ AVRNT or ORT w/ concealed conduction. Yeh SJ 1984 (113) Effect of diltiazem and as 15 Combination diltiazem 120 160 mg vs. placebos Direct comparison on 2 consecutive d Inducible PSVT AVRT (n=13) AVNRT (n=2) N/A W/ placebo PSVT lasted 164±89 min; 4 pts had spontaneous conversion. W/ diltiazem and propranolol PSVT lasted 39±49 min (p<.001). 14 pts had spontaneous conversion in an average of 27 ±15 min. None of the 14 pts had electrical reinduction of sustained PSVT after conversion. Outpatient f/u w/ 50/51 conversion of PSVT w/in 21±16 min, f/u of 5.6 mo. The heart rate was 87±16 bpm before and 59±10 bpm at 90 min after diltiazem and propranolol (p<0.001). The systolic and diastolic pressures were, respectively, 111±11 and 77±10 mm Hg before and 88 + 9 and 66 + 9 mm Hg after diltiazem and propranolol (p<0.001) N/A N/A Single dose of terminated acute PSVT Limited due to EP study efficacy and low numbers of AVNRT pts. Not placebo controlled. Efficacy 71 Esmolol Placebo “SVT” (HR>120) VHD, AV block, Therapeutic Hypotension N/A p=NS Rapid onset
in patents w/ PSVT, PAF, atrial flutter mg twice daily) PSVT (n=14, Group 1) PAF or parosysmal atrial flutter (n=28, Group 2) 30 d intervals had CHF (NYHA . (29%) had no tachycardia while taking placebo. Number w/ no tachycardia increased w/ progressively larger flecainide doses; w/ the 150 mg twice daily dose, 12 (86%) of 14 pts had no tachycardia (p<0.01 for overall differences among all treatments). premature study discontinuation during flecainide treatment periods (5 pts in Group 1 and 6 pts in Group 2). Pritchett EL 1991 (28) Oral to prevent PSVT phase, w/ each period lasting up to 60 d. 23 Propafenone (n=23) Placebo (n=23) PSVT (n=14) PAF (n=9) Angina during tachycardia, pulmonary edema, neurologic sxs. PAF w/ WPW syndrome, on AADs Compared w/ placebo, propafenone caused an increase in time to first recurrence of arrhythmia (p=0.004) PSVT: p=0.03 PAF: p=0.06 . Cardiac AEs occurred only in pts w/ PAF (9/11): 2 w/ prolonged episode of AF, 1 w/ atrial flutter w/ a mean ventricular rate of 263 bpm recorded using the telephone monitor. N/A N/A Propafenone efficacious in treating PSVT and PAF. Major limitation in not knowing how many pts had AVNRT. . AH 1992 Efficacy and safety of 87 AVNRT Diltiazem Placebo Induction of PSVT w/ PES, required to have a rate of 120 Pts w/ severe congestive heart failure, sinus node Conversion to sinus rhythm occurred in 4 N/A Most frequent adverse N/A IV diltiazem in doses of 0.15, 0.25 and 0.45 d, one
(115) IV diltiazem (n=25) AVRT (n=60) AT (n=2) bpm and to persist for 115 min. dysfunction, pregnancy, myocardial infarction w/in 2 wk of study, or hypotension (SBP <90 mm Hg) of 14 pts (29%) w/ 0.05 mg/kg of diltiazem, 16 of 19 (84%) w/ 0.15 mg/kg, 13 of 13 (100%) w/ 0.25 mg/kg, and 14 of 17 (82%) w/ 0.45 mg/kg compared w/ 6 of 24 (25%) treated w/ placebo. Conversion rates in groups receiving doses of 0.15 to 0.45 mg/kg of diltiazem were superior to that in the placebo group (p<0.001). Time to conversion was 3.0±2.6 min in responding diltiazem pts compared w/ 5.9±6.1 min in responding control pts. response to diltiazem was hypotension (7 of 63 pts); however, only 4 pts had sxs related to hypotension. mg/kg is effective and safe for acute management of PSVT. JL 1994 (29) efficacy of (≥6 mo) 49 PSVT (n=21) PAF (n=28) Flecainide Placebo Pts enrolled from 3 prior studies evaluating short-term flecainide efficacy (2 above, Pritchett and Henthorn—one [Anderson, 1989]) not tabulated above due to PAF-only Syncope, angina, or transient cerebral events during PSVT, second or third degree AV block or had CHF (NYHA -Number of pts w/o attacks -Time to first attack -Interval between attacks -Average No pt experienced proarrhythmia, MI, or died during chronic efficacy study. N/A N/A Supports flecainide for chronic therapy of PSVT. Small numbers of pts w/ PSVT, n
responded to diltiazem while only 4/16 pts responded to esmolol (p<0.001) Of the 28 pts who responded to diltiazem, in 13 pts the second bolus of diltiazem worked after the first had failed. poor efficacy for terminating PSVT, even when 2 boluses are administered. Alboni P 2001 (36) to of PSVT, 33 Flecainide (n=33) Diltiazem/ propranolol (n=33) Placebo (n=33) AVNRT and AVRT confirmed by EP study Well-tolerated (no sxs of dyspnea, syncope, presyncope, no interference w/ normal activities Infrequent (≤5 episodes/y) w/ ≥1 ED visit/y PSVT documented by ECG Preexcitation, CAD, resting bradycardia <50 bpm, LVEF <50%, h/o HF, severe “general diseases,” recent MI or CVA, acute illness, need for AADs, h/o sustained atrial/ventricular tachyarrhythmias Conversion to sinus rhythm occurred w/in 2 h in 52%, 61%, and 94% of pts on placebo, flecainide and diltiazem/ propranolol, respectively (p<0.001) The conversion time was shorter after diltiazem/ propranolol (32±22 min) than after placebo (77±42 min, p<0.001) or flecainide (74± 37 min, p<0.001). 26 pts discharged on Four pts (1 placebo, 1 diltiazem/ propranolol, and 2 flecainide) had hypotension and four (3 diltiazem/ propranolol and 1 flecainide) a sinus rate <50 bpm following SVT interruption N/A N/A Use of these agents is efficacious in acute therapy, both w/ and outpt therapy. However, only 4/5 pts discharged on flecainide. Complications not trivial and all pts w/ EP study.
(37) to and placebo in the of PSVT Propafenone (n=41) bradycardia (<50 bpm), AV block, prolonged QTc, MI, unstable angina, recent sudden death, hematologic /hepatic/renal disease dofetilide, propafenone, and placebo had a 50%, 54%, and 6% probability, respectively, of remaining free of episodes of PSVT (p<.001 for both dofetilide and propafenone vs. placebo). The hazard ratio for dofetilide vs. placebo was 0.33 (95% CI: 0.18-0.61), and the hazard ratio for propafenone vs. placebo was 0.27 (95% CI: Of 40 pts treated w/ dofetilide and propafenone, 23 (58%) and 25 (61%) had no recurring PSVT, compared w/ 16 (39%) in placebo group. and 21 of 41 (51%) treated w/ propafenone reported no adverse events. No significant differences were noted between 3 groups in incidence of adverse events or adverse events (p=0.73 and p=0.74, respectively). as propafenone as an alternative therapeutic option for the treatment of pts w/ PSVT. Limited in that PSVTs not specified. Catheter Therapy (including cyroablation vs. RFA studies) JJ 1993 (116) Slow vs. fast path ablation for 50 Anterior (n=22) Up to 1 h or 10 RF Posterior (n=28) Up to 1 h or AVNRT None stated Primary success rates, anterior vs. posterior One pt w/ RBBB during an anterior lesion N/A N/A Posterior (slow path) approach to RF
Small sample; probability of detecting a 20% difference in efficacy between two techniques only 0.67. HA 2003 (118) of and mapping in guiding catheter ablation of AVNRT 20 mapping (n=10) Fluoroscopic mapping (n=10) AVNRT None stated vs. fluoroscopy: Fluoroscopic duration: 12.6±6.8 vs. 35.9±18.3 min, p<0.001 Fluoroscopic exposure (0.7±0.5 vs. 9.6±5.0 min; p<0.001 Total procedure time: 83.6±23.6 vs. 114±19.3 min, p=0.008 Total fluoroscopic exposure: 4.2±1.4 vs. 15.9±-6.4 min, p<0.001 Number of RF applications: 2.7±1.6 vs. 5±2.8, p=0.018, Duration of RF: 165.3±181.6 No acute or long-term 8.9±2.2 mo) complications or arrhythmia recurrence in either group N/A N/A mapping offers significantly shorter procedure and fluoroscopy times, improving the efficiency of the procedure and reducing X-ray exposure. Small sample size, curious lack of side effects. Cost higher w/ mapping catheter, but likely offset by potential for improved efficiency, pt throughput and X-ray exposure from reductions in procedure and fluoroscopy times.
block ranged from 2-420 in CA group and from 2-180 in RF group Kardos A 2007 (121) Test the of during AVNRT and AVRT Note: ablation only if the w/o of AV 30 AVNRT n=17 AVRT n=13 after dx of AVRT or AVNRT made 9 APS in CA, 4 in RF CA (n=13 RFA (n=17) AVNRT or AVRT w/ anteroseptal pathway AVRT w/ a posteroseptal, or right free wall AP CA vs. RFA Overall acute success rate: 85 vs. 82.4%, p=0.43 CA: in one pt, ablation not attempted because of AV prolongation RFA: two pts w/ temporary second-degree AV block CA vs. RFA Long-term success rate (12 mo f/u) similar between the two groups Fluoroscopy and the procedure time similar (p=0.37 and p=0.14, Mean number of applications: 2 (1-6) vs. 7 (1-41), p=0.002 N/A First study to assess ICE mapping guided ablation in a prospective randomized method. Cryomapping a feasible method to determine exact location of APs and of slow pathway during tachycardia. Cryomapping performed during tachycardia causes less ablation lesions w/o increasing procedure and fluoroscopy times. Pediatric pts eligible and pts in CA group younger (median age 20 vs. 44). No control, and arguably 2 groups not respectively)
flutter. allowed to receive diltiazem if placebo had been given. whereas 7 of 57 pts (12%) responded to placebo. Van Gelder IC 1989 (181) Efficacy and safety of acetate in the of sinus rhythm after electrical of chronic AF or atrial flutter. 81 pts N/A N/A Chronic AF or flutter Age <16 or >80 y; CHF or angina pectoris > III (NYHA); MI <2 y, flecainide intolerance, BBB, SSS w/o pacemaker, antiarrhythmics, severe systemic disease Multiple regression analysis showed New York Heart Association class I for exercise tolerance (p=0.0004) and flecainide treatment (p=0.01) to be the main factors increasing the episode. However, Mantel-Cox lifetable analysis did not reveal significant differences between survival curves of both treatment groups. In the group, 9% of pts experienced side effects, mostly related to negative dromotropic effects. The incidence of ventricular proarrhythmia N/A N/A N/A 9% of pts treated w/ flecainide had adverse events (e.g,sinus arrest, AV block, rate related LBBB). Moderate doses of flecainide (not >300 mg) recommended after cardioversion label
Efficacy and safety of IV (2 mg/kg per 10 min) vs. (2 mg/kg per 10 min) vs. 10 mg in 1 min.in pts w/ AF or flutt or atrial flutter >2 d w/o appropriate anticoagulants, body weight >100 kg flecainide conversion 24/25 (96%) vs. 8/14 (57%) propafenone, p<0.05. 1/8 (13%) atrial flutter w/ flecainide 2/5 (40%) atrial flutter propafenone, p=NS Overall verapamil 1/20 (5%) (83±11 to 86±12 msec). QRS widening more common w/ flecainide than propafenone (p<0.001) was not effective at converting AF or atrial flutter w/in 1 hr Roberts SA 1993 (186) Clinical and cost of digoxin at HR in AF and atrial flutter in , study at 18 centers 115 pts Assessed time to HR control w/ digoxin N/A 18 y AF or atrial flutter w/ ventricular rates ≥ 120 BPM NYHA class III, IV, HF, surgery, AMI The median time to ventricular rate control (i.e., resting ventricular rate <100 bpm, decrease in ventricular rate of >20%, or sinus rhythm) was 11.6 h from the first dose of digoxin for all evaluable pts (n = 105) and 9.5 h for those only receiving digoxin (n = 64). Before ventricular rate control, the mean ±SD dose of N/A N/A N/A Observational study
medications (p<0.05). 3) Sense of well being (pre-RF 2.0±0.3 vs. post-RF 3.8±0.5, p<0.01) and function in daily life 2.3±0.4 vs. post-RF 3.6±0.6, p<0.01) improved after ablation, but did not change significantly in pts treated w/ drugs. E 2001 (199) Ablation: Single center, trial ablation of multi IART circuits in adults w/ CHD guided by mapping w/ and w/o 3D mapping 20 pts (47 circuits) To define an approach for mapping and ablation, combining anatomy, activation sequence data and entrainment mapping. a) 7 pts w/ ablation guided by entrainment mapping only b)13 pts w/ ablation guided by entrainment and 3D mapping N/A Recurrent IART refractory to meds. Late post repair of CHD Overall 38 (81%) of 47 IARTs successfully ablated. In f/u ranging from 3-46 mo: a)16 (80%) of 20 pts remains free of recurrence b)Success similar in both groups but fluoroscopy time decreased from 60 +/- 30 to 24 +/- 9 min/procedure w/ addition of 3D mapping N/A N/A No statistical analysis Entrainment mapping combined w/ 3D mapping allows delineation of complex circuits and critical isthmuses as targets for RFA as a satisfactory treatment modality for IARTs related to CHD. Delle To IV diltiazem N/A Critically ill pts w/ N/A Sustained Bradycardia or Uncontrolled 1° endpoint: NS The study
of atrial of flutter arrhythmias of varying duration. flutter= 68% at 100 J c) AF of >30 d duration, shocks of <200 J = 6.1% d) AF >180 d= 2.2% at 200 J protocols, particularly w/ AF of longer duration. Wazni 2003 (203) study atrial junction and isthmus ablation vs. atrial junction alone in pts w/ typical atrial flutter and AF. 108 Consecutive pts w/ documented symptomatic AF and typical atrial flutter were randomly assigned to have PV-LAJ disconnection combined w/ CTI ablation (group 1, n=49) or disconnection alone (group 2, n=59). PV-LAJ disconnection combined w/ CTI ablation (group 1, n=49) or disconnection alone Preablation proof of both atrial flutter and AF on ECG, 1 documented episode of typical atrial flutter while not on antiarrhythmics N/A W/in the first 8 wk after ablation, 32 of the group 2 pts had typical atrial flutter documented, whereas none was seen in group 1. Twenty of these 32 converted to sinus rhythm after initiating AADs. Twelve were cardioverted, and AADs were started. After 8 wk, all AADs were stopped, and only 3 pts continued to have recurrent sustained typical atrial flutter that was eliminated by CTI ablation. Beyond 8 wk of f/u, 7 pts in group 1 and 6 pts in group 2 (14% and 11%, continued to N/A N/A N/A Isolating of all 4 pulmonary vs. is challenging. No f/u beyond 1 y.
ablation of common atrial flutter using and RF energy: The study BCB confirmed in 85% of the RF group vs. 65.6% of the cryoablation group. 4)The primary end-point= of BCB block was seen in 15% of the RF group vs. 34.4% of the cryoablation group (P<0.014). C 2009 (206) placebo Trial: Assess w/ for w/ Ibutilide: 117 pts (58 w/ and 59 w/o of 65 w/ typical atrial flutter and 52 w/ 117- 65 typical flutter; 52 atypical flutter 2 randomized groups: Group 1) 4 of IV magnesium sulfate Vs. Group 2) placebo immediately before administration of a maximum dose of 2 mg of ibutilide fumarate Typical and atypical atrial flutter N/A 1) TAF: IV magnesium improved efficacy of ibutilide for conversion (85% w/ magnesium vs. 59% w/ placebo, p=0.017). Atypical atrial flutter: no significant difference in conversion rates between pts receiving magnesium vs. placebo (48% vs. 56%,p=0.189) No effect of magnesium on QTc interval. QTc intervals at 30 min after ibutilitde did not differ between patients w/ and w/o ventricular ectopy N/A Preinjcention w/ Mg superior for conversion w/ ibutilide in trypical atrial flutter (p=0.017) Preinjection w/ Mg for conversion w/ ibutilide no different (p=NS) Preinjection wih Mg did not affect QT (no statistic offered) Pre-injection of magnesium significantly enhances the efficacy of ibutilide for the conversion of typical atrial flutter but not of atypical atrial flutter. der
Mean cost of the procedure was $10,183±$1,082 in 30 pts studied for cost analysis. 22 outpts vs. 8 overnight pts : Total charges: $9,873 vs. $11,034 (p<0.01) Professional fees: $6,163 vs. $6,286 (p=NS) Hospital charges: $3,710 vs. $4,748 (p<0.01) 2 pts w/ complications: femoral artery pseudoaneurysm notes 3-4 wk after procedure, one in outpt, one after 13 h overnight stay. Kertes PJ 1993 (389) CE of RFA compared to AADs in Australia 26 AVNRT (n=16) WPW (n=10) Mean cost of RFA $4067, c/w AAD of $700/ y NOTE: these are likely Australian dollars, although authors do not specify Extrapolating over 20 y and allowing for an annual 5% inflation factor, RFA becomes cost saving in 5.5 y Over 20 y, AAD estimated at times more expensive than RF Perspective: pt and societal Outcomes: cost analysis w/ “cost-saving” criterion used to define effectiveness, on the assumption that RFA is at least as effective as AADs in control of PSVT; authors used annual charges N/A RFA more cost-effective than AADs. Limited to Australian population, but results consistent w/ other series. Used pt data in constructing not simulation. Ikeda T 1994 (390) Prospective cohort, CE evaluation of CE of RFA for PSVT 20 Symptomatic PSVT, on AADs, all w/ successful RFA AVNRT (n=5) WPW (n=15) Mean total charge for ablation 982,806 yen and 5.7 times the outpt charges in the previous y Mean total life-expectancy N/A Small study, limited to Japan, but suggests RFA effective and reduces medical costs. Utilizes hospital charges, and not a