Atrial fibrillation (AF) is the most common cardiac arrhythmia in the US population
(Fuster, 2006). AF can be asymptomatic but it may also be associated with shortness of
breath, difficulty with exercise, palpitations, general fatigue, dizziness, and confusion.
Importantly, AF is the second-leading cause of stroke, after atherosclerosis (Heron, 2009);
the risk of stroke among those with AF is estimated to be fivefold higher than in patients
without this disorder (National Stroke Association, 2010).

ICER’s research concluded that catheter ablation following a course of treatment with an anti-arrhythmic drug, while more costly, was substantially more effective at maintaining a normal heart rhythm than an anti-arrhythmic drug alone.  Dronedarone, a newer anti-arrhythmic drug, was found to have both comparable effectiveness and comparable costs as compared to amiodarone, a commonly used anti-arrhythmic drug.  However, ICER’s review found the evidence on the effectiveness of surgical ablation to be insufficient to make a determination of comparative clinical effectiveness or comparative value.  For all of the interventions examined, there was far less information available on older, sicker patients, therefore ICER was not able to make any determination about comparative effectiveness in those populations.

Interventions of interest:

  • Antiarrhythmic drug therapy to return the heart to sinus rhythm
  • Radiofrequency catheter ablation to terminate AF and prevent further episodes
  • Minimally-invasive surgical techniques to terminate AF and prevent further episodes
  • Aspirin, warfarin, and dabigatran for anticoagulation to prevent strokes
  • The WATCHMAN left atrial appendage occlusive device to prevent strokes

Date of review: September 2010

For questions, contact info@icer.org.

Final Documents

Below you will find the final documents from the assessment review process:

“There are several recent innovations in the treatment of AF patients that have both created difficulty for patients and clinicians trying to choose the right strategy, and presented payers with challenges as they attempt to make policies that support appropriate care. Not only does our report help to synthesize the existing evidence, but it also frames the key evidence gaps that should help set research goals for the future.”