Arrhythmias & electrophysiology
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 randomized controlled trial
Authors' conclusion
In symptomatic LSPAF, CA and SA were equally effective at achieving arrhythmia outcomes (freedom from AF/AT ≥30 seconds and ≥75% burden reduction) after a single procedure without antiarrhythmic drugs. However, SA is significantly more costly than CA.
Study context
- Population
- Patients with long-standing persistent AF (long-standing persistent atrial fibrillation (LSPAF))104 (90.4%) completed 36 months
- Participants
- 115 patients
- Comparison
- Catheter ablation vs thoracoscopic surgical ablation
- Primary endpoint
- Freedom from AF/atrial tachycardia ≥30 seconds after a single procedure without antiarrhythmic drugs (implantable loop recorders)
- Follow-up
- 36 months
Methodological detailsFollow-up 3 years with implantable loop recorders and questionnaires
- Follow-up 3 years with implantable loop recorders and questionnaires
Primary result
As reported in the abstract
Freedom from AF/AT ≥30 seconds, single procedure, no antiarrhythmic drugs
Hazard ratio
1.22
95% CI 0.81–1.83
P = 0.41
Events by treatment group
CAvs SA
HR 1.22 (95% CI 0.81–1.83); P = 0.41
Further findings
| Outcome | CA | SA | HR (95% CI) | P value | |
|---|---|---|---|---|---|
| AF/AT burden reduced by ≥75% · 36 months | 58% | 55% | 1.04 (0.57–1.88) | P = 0.91 | |
| 0.512Hazard ratio (log scale) |
Quality-adjusted life years · 36 months
Mean £
| Outcome | CA | SA |
|---|---|---|
| Estimated costs · 36 months | 18,002 (95% CI £15,422-£20,581) | 24,682 (95% CI £21,746-£27,618) |
Quality-adjusted life years · 36 months
- Overall impact on health-related quality of life similar
Original publication
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 randomized controlled trial. Heart Rhythm. Published 17 May 2024. doi:10.
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