Key result
Cryoablation resulted in a lower long-term success rate at 6 months compared to radiofrequency ablation for atrioventricular nodal re-entrant tachycardia in children (79.1% vs 92.8%; p=0.01).
Why the study?
Does cryoablation compared to radiofrequency ablation improve value (cost and success) in children with atrioventricular nodal re-entrant tachycardia?
Cohort (n=96)
No
Does cryoablation compared to radiofrequency ablation improve value (cost and success) in children with atrioventricular nodal re-entrant tachycardia?
Absolute Event Rate: 79.1% vs 92.8%
p-value: p=0.01
Cryoablation and radiofrequency ablation offer similar short-term value and costs for pediatric AVNRT, but radiofrequency ablation may have higher long-term success rates.
Radiofrequency ablation may be favored for higher long-term success in pediatric AVNRT; leaves open confirmation by randomized trials.
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.
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Oster et al. (2016) conducted a cohort in Atrioventricular nodal re-entrant tachycardia (n=96). Cryoablation vs. Radiofrequency ablation was evaluated on Long-term success (6 months) (p=0.01). Cryoablation resulted in a lower long-term success rate at 6 months compared to radiofrequency ablation for atrioventricular nodal re-entrant tachycardia in children (79.1% vs 92.8%; p=0.01).
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