Analysis

Caution over use of catheter ablation for atrial fibrillation

BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f5277 (Published 06 September 2013) Cite this as: BMJ 2013;347:f5277

This article has a correction. Please see:

  1. Hans Van Brabandt, cardiologist12,
  2. Mattias Neyt, researcher1,
  3. Carl Devos, researcher1
  1. 1Belgian Health Care Knowledge Centre, Brussels 1000, Belgium
  2. 2 Belgian Centre for Evidence-Based Medicine and Branch of the Dutch Cochrane Centre, Leuven, Netherlands
  1. Correspondence to: H Van Brabandt hans.vanbrabandt{at}kce.fgov.be

Catheter ablation is an increasingly used treatment for atrial fibrillation but Hans Van Brabandt, Mattias Neyt, and Carl Devos argue that enthusiasm for the procedure is not justified by the evidence on efficacy and cost effectiveness and its use should be strictly limited

More than 10 years after its introduction radiofrequency ablation for atrial fibrillation has become a common procedure in both Europe and the United States. In the United Kingdom around 6500 procedures were carried out in 2011-12 and numbers are rising.1 Belgium has also seen an appreciable rise in the rate of catheter ablation from 993 procedures in 2008 to 2064 in 2010,2 with about 15% of the 2008 procedures being first line treatments.2 3 But concern has been voiced that the efficacy of catheter ablation has been exaggerated and the risks to patients underplayed, and this view is supported by the results of a recent health technology assessment carried out by the Belgian Health Care Knowledge Centre, which raises serious questions about the effectiveness and cost effectiveness of catheter ablation and the evidence that underpins current European guidelines.4

Need for treatment

Atrial fibrillation is the most common heart rhythm disorder, affecting 1.5-2% of the general population. The prevalence of the condition seems to be increasing. In the United Kingdom, for example, the number of admissions to NHS hospitals has risen by 60% in the past 20 years, and the total cost to the NHS is calculated to be £2.2bn (€2.6bn; $3.4bn) a year. Some projections suggest that these numbers are likely to double by 2050.4 5

Although atrial fibrillation can cause symptoms of palpitations or dyspnoea, a third of patients remain unaware of the condition.4 Patients with atrial fibrillation may develop arterial embolism, particularly those who are older or have underlying structural …

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