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People who suffer frequent attacks of one type of heart arrhythmia can benefit substantially from nondrug therapy

Individuals who suffer frequent, severe attacks of a certain form of heart arrhythmia—supraventricular tachycardia—can benefit from a treatment that improves their quality of life and is more cost effective than long-term drug therapy, concludes a study supported by the Agency for Healthcare Research and Quality (HS08362).

Supraventricular tachycardia is caused by a misdirection of an electrical signal in the heart. It usually is not life-threatening, but it can cause an individual to feel light-headed or even faint. If the episodes are particularly severe or occur often, they can interfere with a person's ability to drive safely and may restrict other activities. Sometimes urgent medical care, including intravenous drug treatment in an emergency room, is needed to get the heartbeat back on track.

Radiofrequency ablation provides an option to long-term drug therapy for patients who suffer from monthly episodes of supraventricular tachycardia. Despite its $8,500 price tag, the procedure substantially improves patient quality of life and reduces costs in patients who have frequent attacks. In this procedure, doctors thread a catheter from a blood vessel near the patient's hip up to the heart. Once there, doctors aim radiofrequency waves at the region of the heart's electrical conduction system responsible for the problem. Heat from the waves destroys the tissue and prevents the signal from going astray. This treatment cures the vast majority of patients, notes Mark Hlatky, M.D., of Stanford University, who is principal investigator of the AHRQ-supported Cardiac Arrhythmia Patient Outcomes Research Team (PORT).

The team found that radiofrequency ablation improved life expectancy by 3 quality-adjusted life-years and reduced lifetime medical expenditures by $27,900 compared with long-term drug therapy. When compared with episodic drug treatment, the procedure saves more than $81,000. This study was part of an ongoing multicenter study of cardiac treatment options. The researchers used a computer-based model to compare the cost and effectiveness of radiofrequency ablation with two other treatments: long-term daily drug therapy and drugs that were given only during an arrhythmia episode.

More details are in "Cost-effectiveness of radiofrequency ablation for supraventricular tachycardia," by Carol H.F. Cheng, B.S., Gillian D. Sanders, Ph.D., Dr. Hlatky, and others, in the December 5, 2000 Annals of Internal Medicine 133, pp. 864-876.

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