Abstract 14484: Elimination of Localized Source Rhythms For Human Atrial Fibrillation is Highly Cost Effective
Introduction: In animals, AF is sustained by localized electrical rotors or focal beats (drivers), yet the existence of such sources is disputed in humans. We hypothesized that ablating these localized sources, as performed in the CONFIRM trial, would be cost-effective compared to conventional.
Methods: In 103 patients, we recorded AF with 64-pole baskets in the atria. We developed a novel computational imaging system to identify rotors or focal drivers of AF. Patients either received (a)FIRM(targeted ablation for 1yr.
Results: Computational imaging revealed AF drivers (rotors or focal beats) in 97% patients. Freedom from AF (Kaplan-Meier) in the CONFIRM trial was substantially higher with FIRM+CONV vs CONV alone (84.3% vs 50.5%,p=0.01; FigA). Cost-modeling using Medicare data revealed average per-patient cost-savings over two years of $8209 with the ablation of localized human AF sources, i.e. a dominant cost-effective result (Fig B).
Conclusions: AF ablation outcomes were significantly better and costs were lower when ablation targeted localized drivers identified with our novel imaging system. This dominant cost benefit compared to conventional ablation may establish a new paradigm in cost effectiveness for AF therapy.
- © 2011 by American Heart Association, Inc.