Aim: Three-dimensional (3D) nonfluoroscopic mapping systems (NMSs) are generally used during the catheter ablation (CA) of complex arrhythmias. We evaluated the efficacy, safety, and economic advantages of using NMSs during His-Bundle CA (HB-CA).
Methods: A total of 124 consecutive patients underwent HB-CA between 2012 and 2019 in our EP Laboratory. We compared two groups: 63 patients who underwent HB-CA with fluoroscopy alone from 2012 to 2015 (Group I) and 61 patients who underwent HB-CA with the aid of NMSs from 2016 to 2019 (Group II). Two cost-effectiveness analyses were carried out: the alpha value (AV) (ie, a monetary reference value of the units of exposure avoided, expressed as $/man Sievert) and the value of a statistical life (VSL) (ie, the amount of money that a community would be willing to pay to reduce the risk of a person's death owing to exposure to radiation, it is not the cost value of a person's life). The cost reduction estimated by means of both these methods was compared with the real additional cost of using NMSs.
Results: The use of NMS resulted in reduced fluoroscopy time in Group II {median 1.35 min} in comparison with Group I {median 4.8 min (P < .05)}. The effective dose reduction (ΔE) was 1.16 milli-Sievert.
Conclusion: The use of NMS significantly reduces fluoroscopy time. However, the actual reduction is modest and in our EP Laboratory this reduction is not cost-effective. Indeed, when the ΔE is referred to country and agency tables for absolute values of AV or VLS, it is not economically advantageous in almost all cases.
Keywords: His‐Bundle catheter ablation; cost‐effectiveness; electroanatomic mapping system; electrophysiological procedures.
© 2020 The Authors. Journal of Arrhythmia published by John Wiley & Sons Australia, Ltd on behalf of the Japanese Heart Rhythm Society.