Long term clinical outcomes and cost-effectiveness of catheter vs thoracoscopic surgical ablation in long-standing persistent atrial fibrillation using continuous cardiac monitoring: CASA-AF randomised controlled trial

Vennela Boyalla; Shouvik Haldar; Habib Khan; Ines Kralj-Hans; Winston Banya; Joanne Lord; Anitha Satishkumar; Toufan Bahrami; Anthony De Souza; Jonathan R Clague; Darrel P Francis; Wajid Hussain; Julian W Jarman; David G Jones; Zhong Chen; Neeraj Mediratta; Jonathan Hyde; Michael Lewis; Raad Mohiaddin; Tushar V Salukhe; Vias Markides; James McCready; Dhiraj Gupta; Tom Wong; CASA-AF Investigators

doi:10.1016/j.hrthm.2024.05.022

Long term clinical outcomes and cost-effectiveness of catheter vs thoracoscopic surgical ablation in long-standing persistent atrial fibrillation using continuous cardiac monitoring: CASA-AF randomised controlled trial

Heart Rhythm. 2024 May 13:S1547-5271(24)02564-5. doi: 10.1016/j.hrthm.2024.05.022. Online ahead of print.

Collaborators

CASA-AF Investigators:
Rashmi Yahdev, Shelley Rahman-Halley, Joyce Wong, Aaisha Opel, Riyaz Kaba, Eva Nyktari, Esther Cambronero-Cortinas, Cemil Izgi, Timothy Fairbairn, Joanne Benton, Ruth Chester, Eliane Cunliffe, Lucy Edmondson, Matthew Gill, Vicky Griffiths, Rebecca Harman, Catherine Huggett, Jenny Keegan, Kevin Kirby, Karen Lascelles, Ramasamy Manivarmane, Iulia Munteanu, Karen O'Brien, Tess Phyl, Shelley Rahman-Halley, Tsveta Rahneva, Cheryl Riley, Paula Rogers, Katherine Smith, Rick Wage, Cathy West, Yakup Yakupoglu, Guang Yang, Audra Audraite, Sandra Belchambers, Susan Hughes, Maureen Morgan, Christina Ronayne, Rob Shaw, Paulinus Simkus, Clive Taylerson, Chloe Bruce, Andrew McGregor, Catherine Thomson, Hollie Granville, Alice Snell, Sophia John, Christiana Monteiro, Grace Augustine, Nichola Sutton

PMID: 38763376
DOI: 10.1016/j.hrthm.2024.05.022

Abstract

Background: Long-term clinical outcomes of catheter ablation (CA) compared to thoracoscopic surgical ablation (SA) to treat patients with long-standing persistent atrial fibrillation (LSPAF) are not known.

Objectives: To compare long-term (36-months) clinical efficacy, quality of life and cost-effectiveness of SA and CA in LSPAF.

Methods: Participants were followed up for 3 years using implantable loop recorder (ILR) and questionnaires to assess change in quality of life. Intention-to-treat analyses were used to report the findings.

Results: Of 115 LSPAF patients treated, 104 (90.4%) completed 36-months follow-up (CA=57, SA=47). Following a single procedure without anti-arrhythmic drugs (AAD) 7 (12%) patients in the CA arm and 5 (11%) in the SA arm (HR 1.22, 95% CI 0.81 to 1.83, p = 0.41) were free from AF/AT ≥30 sec at 36 months. Thirty-three patients (58%) in the CA arm and 26 (55%) in the SA arm (HR 1.04, 95% CI 0.57 to 1.88, p = 0.91) had their AF/AT burden reduced by ≥75%. The overall impact on health-related quality of life was similar, with mean QALY estimates of 2.45 (95% CI 2.31 to 2.59) for CA and 2.32 (2.13 to 2.52) for SA. Estimated costs were higher for SA (mean £24,682, 95% CI £21,746 to £27,618) than for CA (mean £18,002, 95% CI £15,422 to £20,581).

Conclusion: In symptomatic LSPAF, CA and SA were equally effective at achieving arrhythmia outcomes (freedom from AF/AT ≥30s and ≥75% burden reduction) following a single-procedure without AADs. However, SA is significantly more costly than catheter ablation.

Keywords: catheter ablation; continuous cardiac monitoring; long-standing persistent atrial fibrillation; long-term follow-up; randomised clinical trial; surgical ablation.