Comparison of 'anatomically designed' and 'point-by-point' catheter ablations for human atrial fibrillation in terms of procedure timing and costs in German hospitals.

AIMS: The purpose of the FAST-PVI study was to compare 'traditional' ablation tools based on 'point-by-point' technology with the new 'anatomically designed' technologies in terms of procedure times and related costs for the treatment of paroxysmal atrial fibrillation.

METHODS AND RESULTS: Four hundred and fifty-two consecutive ablation procedures (222 'anatomically designed', 136 Arctic Front® and 86 PVAC®) and 230 'point-by-point' ablations (100 CARTO XP and 130 NavX navigation systems) performed by nine university centres across Germany from 2006 to 2010 were evaluated retrospectively. Staffing and resources times for each procedure were documented together with patient morbidities, complications, and pulmonary veins isolations. On the basis of DRG data from 2006 to 2010, human resources use and equipment maintenance costs were assigned to ablation procedure and calendar year. All procedural times were significantly higher in 'point-by-point' technologies compared with 'anatomically designed' ablations [average lab occupancy time 185.30 vs. 280.28 min; physician time 152.21 vs. 238.04 min; support time 183.43 vs. 278.34 min and fluoroscopy time 29.11 vs. 40.72 min; P < 0.001 (95% confidence interval, CI)]. For each ablation procedure human resource use per operating minute resulted in lower costs for 'anatomically designed' ablations [€744.24 per patient; P < 0.001 (95% CI)]. Savings due to reduced duration in 'anatomically designed' technologies accrued to 20% lower human resource costs. Sensitivity analyses did not lead to any significant variations on the outcomes parameter cost per minute.

CONCLUSION: FAST-PVI showed reductions in ablation procedural time may lead to increased hospital capacity and non-device-related cost-savings, while maintaining quality.