Cost-effectiveness of pulsed field ablation of atrial fibrillation: a primer

Catheter ablation is increasingly used as a primary or first-line rhythm-control strategy in the treatment of atrial fibrillation (AF). Pulsed field ablation (PFA) is an emerging catheter ablation modality that offers comparable clinical effectiveness as thermal ablation whilst avoiding safety events related to thermal injury and improving procedural efficiency. PFA may be associated with increased equipment costs. Cost-effectiveness analyses (CEA) help inform adoption of newer technologies such as PFA within healthcare systems with limited resources.

Accordingly, our review provides a primer for CEA and examines the evidence for PFA. Recent studies have demonstrated that PFA is at least as effective as conventional thermal ablation (radiofrequency or cryoballoon) in treating AF and may be an effective first-line rhythm control therapy. PFA is associated with shorter procedural times which increases throughput and may help to offset higher equipment costs.

Preliminary work suggests that PFA is likely cost-effective but findings must be interpreted with caution as there are a limited number of CEA and follow-up was generally limited to 1 year post ablation. Additional CEA across healthcare jurisdictions with longer time horizons are required to confirm these findings and may inform uptake of PFA.