Advertisement

Pediatric Cardiology

, Volume 39, Issue 8, pp 1581–1589 | Cite as

A Cost-Effective Analysis of Systematically Using Mapping Systems During Catheter Ablation Procedures in Children and Teenagers

  • Massimiliano MariniEmail author
  • Daniele Ravanelli
  • Fabrizio Guarracini
  • Maurizio Del Greco
  • Silvia Quintarelli
  • Anna Cima
  • Alessio Coser
  • Marta Martin
  • Aldo Valentini
  • Roberto Bonmassari
Original Article
First Online:

Abstract

The aim of this study is to evaluate the cost-effectiveness of an extended use of 3D non-fluoroscopic mapping systems (NMSs) during paediatric catheter ablation (CA) in an adult EP Lab. This study includes 58 consecutive patients (aged between 8 and 18) who underwent CA from March 2005 to February 2015. We compare the fluoroscopy data of two groups: group I, patients who underwent CA from 2005 to 2008 using only fluoroscopy, and group II, patients who underwent CA from 2008 to 2015 performed also using NMSs. Two cost-effectiveness analyses were carried out: the first method was based on the alpha value (AV), and the second one was based on the value of a statistical life (VSL). For both methods, a children’s correction factor was also considered. The reduction cost estimated from all these methods was compared to the real additional cost of using NMSs. The use of an NMS during a CA procedure has led to an effective dose reduction (ΔE) of 2.8 milli-Sievert. All presented methods are based on parameters with a wide range of values. The use of an NMS, applying directly AV values or VSL values, is not cost-effective for most countries. Only considering the children’s correction factor, the CA procedure using an NMS seems to be cost-effective. The cost-effectiveness of a systematic use of NMSs during CA procedures in children and teenagers remains a challenging task. A positive result depends on which value of AV or VSL is considered and if the children’s correction factor is applied or not.

Keywords

Electrophysiological procedures Paediatric population Non-fluoroscopic imaging Electro anatomic mapping system Cost-effectiveness 
This is a preview of subscription content, log in to check access.

Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Research Involving Human and Animal Participants

This article does not contain any studies with animals performed by any of the authors.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Blomström-Lundqvist C, Scheinman MM, Aliot EM et al (2003) ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias—executive summary. a report of the American college of cardiology/American heart association task force on practice guidelines and the European society of cardiology committee for practice guidelines (writing committee to develop guidelines for the management of patients with supraventricular arrhythmias) developed in collaboration with NASPE-Heart Rhythm Society. J Am Coll Cardiol 42:1493–1531CrossRefGoogle Scholar
  2. 2.
    Aliot EM, Stevenson WG, Almendral-Garrote JM et al (2009) EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias: developed in a partnership with the European Heart Rhythm Association (EHRA), a Registered Branch of the European Society of Cardiology (ESC), and the Heart Rhythm Society (HRS); in collaboration with the American College of Cardiology (ACC) and the American Heart Association (AHA). Europace 11:771–817CrossRefGoogle Scholar
  3. 3.
    Van Hare GF, Javitz H, Carmelli D et al (2004) Prospective assessment after pediatric cardiac ablation: demographics, medical profiles, and initial outcomes. J Cardiovasc Electrophysiol 15:759–770CrossRefGoogle Scholar
  4. 4.
    Kugler JD, Danford DA, Houston KA (2002) Pediatric radiofrequency catheter ablation registry success, fluoroscopy time, and complication rate for supraventricular tachycardia: comparison of early and recent eras. J Cardiovasc Electrophysiol 13:336–341CrossRefGoogle Scholar
  5. 5.
    Perisinakis K, Damilakis J, Theocharopoulos N et al (2001) Accurate assessment of patient effective radiation dose and associated detriment risk from radiofrequency catheter ablation procedures. Circulation 104:58–62CrossRefGoogle Scholar
  6. 6.
    Hirshfeld JW Jr, Balter S, Brinker JA et al (2005) ACCF/AHA/HRS/SCAI clinical competence statement on physician knowledge to optimize patient safety and image quality in fluoroscopically guided invasive cardiovascular procedures: a report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training. Circulation 111:511–532CrossRefGoogle Scholar
  7. 7.
    Committee to Assess Health Risks from Exposure to Low Levels of Ionizing Radiation; Nuclear and Radiation Studies Board DoEalS; National Research Council of the National Academies (2006) Health risks from exposure to low levels of ionizing radiation: BEIR VII 2. The National Academies Press, Washington, DCGoogle Scholar
  8. 8.
    Andreassi MG (2009) Radiation risk from pediatric cardiac catheterization: friendly fire on children with congenital heart disease. Circulation 19:1847–1849CrossRefGoogle Scholar
  9. 9.
    Bacher K, Bogaert E, Lapere R et al (2005) Patient-specific dose and radiation risk estimation in pediatric cardiac catheterization. Circulation 111:83–89CrossRefGoogle Scholar
  10. 10.
    Ait-Ali L, Andreassi MG, Foffa I et al (2010) Cumulative patient effective dose and acute radiation-induced chromosomal DNA damage in children with congenital heart disease. Heart 96:269–274CrossRefGoogle Scholar
  11. 11.
    Sporton SC, Earley MJ, Nathan AW et al (2004) Electroanatomic versus fluoroscopic mapping for catheter ablation procedures: a prospective randomized study. J Cardiovasc Electrophysiol 15:310–315CrossRefGoogle Scholar
  12. 12.
    Earley MJ, Showkathali R, Alzetani M et al (2006) Radiofrequency ablation of arrhythmias guided by non-fluoroscopic catheter location: a prospective randomized trial. Eur Heart J 27:1223–1229CrossRefGoogle Scholar
  13. 13.
    Stabile G, Scaglione M, Del Greco M et al (2012) Reduced fluoroscopy exposure during ablation of atrial fibrillation using a novel electroanatomical navigation system: a multicentre experience. Europace 14:60–65CrossRefGoogle Scholar
  14. 14.
    Casella M, Pelargonio G, Dello Russo A et al (2011) “Near-zero” fluoroscopic exposure in supraventricular arrhythmia ablation using the EnSite NavX™ mapping system: personal experience and review of the literature. J Interv Card Electrophysiol 31:109–118CrossRefGoogle Scholar
  15. 15.
    Smith G, Clark JM (2007) Elimination of fluoroscopy use in a pediatric electrophysiology laboratory utilizing three-dimensional mapping. Pacing Clin Electrophysiol 30:510–518CrossRefGoogle Scholar
  16. 16.
    Kwong W, Neilson AL, Chiu CC et al (2012) The effect of NavX on fluoroscopy times in pediatric catheter ablation. J Interv Card Electrophysiol 33:123–126CrossRefGoogle Scholar
  17. 17.
    Drago F, Silvetti MS, Di Pino A et al (2002) Exclusion of fluoroscopy during ablation treatment of right accessory pathway in children. J Cardiovasc Electrophysiol 13:778–782CrossRefGoogle Scholar
  18. 18.
    Papagiannis J, Tsoutsinos A, Kirvassilis G et al (2006) Nonfluoroscopic catheter navigation for radiofrequency catheter ablation of supraventricular tachycardia in children. PACE 29:971–978CrossRefGoogle Scholar
  19. 19.
    Casella M, Dello Russo A, Pelargonio G et al (2012) Rationale and design of the NO-PARTY trial: near-zero fluoroscopic exposure during catheter ablation of supraventricular arrhythmias in young patients. Cardiol Young 22:539–546CrossRefGoogle Scholar
  20. 20.
    Miyake CY, Mah DY, Atallah J et al (2011) Nonfluoroscopic imaging systems reduce radiation exposure in children undergoing ablation of supraventricular tachycardia. Heart Rhythm 8:519–525CrossRefGoogle Scholar
  21. 21.
    ICRP (2007) The 2007 recommendations of the International Commission on Radiological Protection. ICRP Publication 103. Ann ICRP 37:2–4Google Scholar
  22. 22.
    Marini M, Del Greco M, Ravanelli D et al (2016) The benefit of a general, systematic use of mapping systems during electrophysiological procedures in children and teenagers: the experience of an adult EP laboratory. Pediatric Cardiol 37:802–809CrossRefGoogle Scholar
  23. 23.
    Environmental Protection Agency (2011) EPA radiogenic cancer risk models and projections for the US Population. EPA 402-R-11-001. Washington, DCGoogle Scholar
  24. 24.
    Wrixon AD, Croft JR, Hudson AP, Robb JD, Morrey ME, Robinson CA, Simmonds JR, Haywood SM, Cooper JR, Shrimpton PC, Wall BF, Webb GAM (1993) Documents of the NRPB Volume 4, No. 2Google Scholar
  25. 25.
    ISOE European Technical Center (2012) Man-Sievert Monetary Value Survey (2012 Update). ISOE Information Sheet No. 55, General Distribution November 2012Google Scholar
  26. 26.
    Office of Nuclear Reactor Regulation (2016) Reassessment of NRC’s Dollar Per Person-Rem Conversion Factor Policy. Final Report. NUREG-1530, Revision 1, Manuscript Completed: September 2016Google Scholar
  27. 27.
    National Research Council (2006) Health risks from exposure to low levels of ionizing radiation: BEIR VII Phase 2. The National Academies Press, Washington, DCGoogle Scholar
  28. 28.
    Johnson JN, Hornik C, Li JS et al (2014) Cumulative radiation exposure and cancer risk estimation in children with heart disease. Circulation 130:161–167CrossRefGoogle Scholar
  29. 29.
    OECD (2011) Valuing mortality risk reductions in regulatory analysis of environmental, health and transport policies: policy implications. OECD, ParisGoogle Scholar
  30. 30.
    Office of Management and Budget (2003) Circular A-4. September 17, 2003Google Scholar
  31. 31.
    Office of Management and Budget, Office of Information and Regulatory Affairs (2014) 2014 Draft report to congress on the benefits and costs of federal regulations and unfunded mandates on state, local, and tribal entitiesGoogle Scholar
  32. 32.
    Williams SH (2013) Statistical children. Yale J Regul 30(1):63–124Google Scholar
  33. 33.
    OECD (2017) Inflation (CPI) (indicator).  https://doi.org/10.1787/eee82e6e-en. Accessed 12 April 2017
  34. 34.
    OECD (2017) Exchange rates (indicator).  https://doi.org/10.1787/037ed317-en. Accessed 12 April 2017
  35. 35.
    Alvarez M, Tercedor L, Almansa I et al (2009) Safety and feasibility of catheter ablation for atrioventricular nodal re-entrant tachycardia without fluoroscopic guidance. Heart Rhythm 6:1714–1720CrossRefGoogle Scholar
  36. 36.
    Ferguson JD, Helms A, Mangrum JM et al (2009) Catheter ablation of atrial fibrillation without fluoroscopy using intracardiac echocardiography and electroanatomic mapping. Circ Arrhythm Electrophysiol 2:611–619CrossRefGoogle Scholar
  37. 37.
    Fernández-Gómez JM, Moriña-Vázquez P, Morales Edel R et al (2014) Exclusion of fluoroscopy use in catheter ablation procedures: six years of experience at a single center. J Cardiovasc Electrophysiol 25:638–644CrossRefGoogle Scholar
  38. 38.
    Anselmino M, Sillano D, Casolati D et al (2013) A new electrophysiology era: zero fluoroscopy. J Cardiovasc Med 14:221–227CrossRefGoogle Scholar
  39. 39.
    Casella M, Dello Russo A, Pelargonio G et al (2016) Near zerO fluoroscopic exPosure during catheter ablAtion of supRavenTricular arrhYthmias: the NO-PARTY multicentre randomized trial. Europace 18:1565–1572CrossRefGoogle Scholar
  40. 40.
    Andreassi MG, Piccaluga E, Guagliumi G et al (2016) Occupational health risks in cardiac catheterization laboratory workers. Circ Cardiovasc Interv 9:e003273CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Massimiliano Marini
    • 1
    Email author
  • Daniele Ravanelli
    • 2
  • Fabrizio Guarracini
    • 1
  • Maurizio Del Greco
    • 3
  • Silvia Quintarelli
    • 1
  • Anna Cima
    • 4
  • Alessio Coser
    • 1
  • Marta Martin
    • 5
  • Aldo Valentini
    • 2
  • Roberto Bonmassari
    • 1
  1. 1.Department of CardiologyS. Chiara HospitalTrentoItaly
  2. 2.Department of PhysicsS. Chiara HospitalTrentoItaly
  3. 3.Department of CardiologyS. Maria del Carmine HospitalRoveretoItaly
  4. 4.Department of CardiologyCazzavillan HospitalArzignanoItaly
  5. 5.Department of Cardiac, Thoracic, and Vascular SciencesUniversity of PadovaPaduaItaly

Personalised recommendations

Cite article

Buy options