A new retrospective study from The Children's Hospital at Montefiore (CHAM) found similar safety and efficacy at lower cost using a novel three-catheter approach for ablation in children with Wolff-Parkinson-White (WPW) syndrome, a condition where an extra, abnormal electrical pathway in the heart causes rapid heart rate or tachycardia. The current standard of care for ablation of left-sided accessory pathways in children with WPW is a five-catheter approach and patients treated with this approach served as the age and gender control match in this study.
These data were presented today at The American College of Cardiology's 62nd Annual Scientific Session in San Francisco.
"With increased concern over healthcare expenditures, it is paramount that we maintain quality, efficacy and safety while also maintaining or reducing costs," said Robert H. Pass M.D., director of the pediatric cardiac catheterization laboratory, CHAM, and associate professor of pediatrics at Albert Einstein College of Medicine of Yeshiva University. "Our study showed that using a three-catheter approach in this patient population can reduce the cost by more than 20 percent with comparable outcomes."
Wolff-Parkinson-White affects one to three people in every 1,000 worldwide. The long-term treatment is catheter ablation, where radiofrequency energy is applied to the extra electrical pathway, disabling the heart's ability to beat irregularly. Typically five catheters are used to monitor both sides of the heart, but in patients with WPW who have a left-sided pathway, an electrocardiogram test prior to the procedure enables surgeons to accurately predict the location of the pathway. That information allows for reduction in the number of catheters used on the right side of the heart.
The four-year study included 56 children with WPW who were treated with catheter ablation. One group (n=28) received the new approach, where three catheters were inserted through the patient's groin and neck and threaded through to the heart where the extra electrical pathway was identified and disabled, and had a 100 percent success rate. The control group (n=28) received the standard, five-catheter approach and had a 96 percent success rate. The average catheter cost was lower in the three-catheter group ($1,940 vs. $2,620).
"In Wolff-Parkinson-White ablation cases where we can predict that a pathway is located on the left side of the heart, we are confident in this method and believe it should be applied more often," said Dr. Pass. "Most importantly, with the growing cost of healthcare, we believe any such effort to provide outstanding and consistent outcomes while garnering significant savings is paramount."
The Pediatric Cardiac Catheterization Laboratory is part of the Pediatric Heart Center at CHAM. It was the first hybrid catheterization lab in the New York metropolitan region, allowing for maximal efficiency and coordination of care for children requiring both surgical and interventional procedures. The Pediatric Heart Center is recognized as a world leader in providing advanced cardiovascular care for young patients with congenital heart diseases, treating patients of all ages, from newborns to adults, from minor arrhythmias to heart transplantation.
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