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Radiofrequency ablation versus cryoablation for atrioventricular nodal re-entrant tachycardia in children: a value comparison

Published online by Cambridge University Press:  18 April 2016

Matthew E. Oster ,
Zhou Yang ,
Kay Stewart-Huey ,
Michelle Glanville ,
Arlene Porter ,
Robert Campbell ,
Brad Webb  and
Margaret Strieper
Matthew E. Oster*
Affiliation:
Children’s Healthcare of Atlanta, Emory University Rollins School of Public Health, Atlanta, GA, United States of America Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, United States of America Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States of America
Zhou Yang
Affiliation:
Department of Health Policy and Management, Emory University Rollins School of Public Health, Atlanta, GA, United States of America
Kay Stewart-Huey
Affiliation:
Children’s Healthcare of Atlanta, Emory University Rollins School of Public Health, Atlanta, GA, United States of America
Michelle Glanville
Affiliation:
Children’s Healthcare of Atlanta, Emory University Rollins School of Public Health, Atlanta, GA, United States of America
Arlene Porter
Affiliation:
Children’s Healthcare of Atlanta, Emory University Rollins School of Public Health, Atlanta, GA, United States of America
Robert Campbell
Affiliation:
Children’s Healthcare of Atlanta, Emory University Rollins School of Public Health, Atlanta, GA, United States of America Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States of America
Brad Webb
Affiliation:
Children’s Healthcare of Atlanta, Emory University Rollins School of Public Health, Atlanta, GA, United States of America
Margaret Strieper
Affiliation:
Children’s Healthcare of Atlanta, Emory University Rollins School of Public Health, Atlanta, GA, United States of America Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States of America
*
Correspondence to: M. E. Oster, MD, MPH, 2835 Brandywine Road, Ste 300, Atlanta, GA 30341, United States of America. Tel: +404 256 2593; Fax: +770 488 9477; E-mail: [email protected]
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Abstract

Background

It is unclear whether cryoablation or radiofrequency ablation offers better value for treating atrioventricular nodal re-entrant tachycardia in children. We aimed to compare the value of these procedures for treating atrioventricular nodal re-entrant tachycardia in children, with value being outcomes relative to costs.

Methods

We performed a retrospective cohort study of all atrioventricular nodal re-entrant tachycardia ablations for children (age⩽18 years) from July, 2009 to June, 2011 at our institution. Costs included fixed costs, miscellaneous hospital costs, and labour costs, and key outcomes were acute and long-term success (6 months) of the ablations. We conducted T-tests and regression analyses to investigate the associations between the ablation procedure type and the cost and success of the ablations.

Results

Of 96 unique cases performed by three paediatric electrophysiologists, 48 were cryoablation only, 42 radiofrequency ablation only, and six were a combination. Acute success was 100% for the cryoablation only and radiofrequency ablation only cases and 83% for the combination cases. There were no notable adverse events. The average total cost was $9636 for cryoablation cases, $9708 for radiofrequency ablation cases, and $10,967 for combination cases (p=0.51 for cryoablation only versus radiofrequency ablation only). The long-term success rate was 79.1% for cryoablation only, 92.8% for radiofrequency ablation only, and 66.7% for the combination (p=0.01 for cryoablation only versus radiofrequency ablation only), but long-term success varied notably by provider.

Conclusions

Cryoablation and radiofrequency ablation offer similar value in the short term for the treatment of atrioventricular nodal re-entrant tachycardia in children. Differences in long-term success may vary substantially by physician, and thus may lead to differences in long-term value.

Keywords

Cryoablationradiofrequency ablationatrioventricular nodal re-entrant tachycardiacomparative effectivenessvalue
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 2 , March 2017 , pp. 224 - 228
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Copyright
© Cambridge University Press 2016 

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