Author + information
- Received February 3, 2020
- Revision received April 9, 2020
- Accepted April 13, 2020
- Published online August 17, 2020.
- Jason G. Andrade, MDa,b,∗ (, )
- Laurent Macle, MDa,
- Atul Verma, MDc,
- Marc W. Deyell, MD, MScb,
- Jean Champagne, MDd,
- Marc Dubuc, MDa,
- Peter Leong-Sit, MDe,
- Paul Novak, MDf,
- Jean-Francois Roux, MDg,
- John Sapp, MDh,
- Clarence Khoo, MDi,
- Jacques Rizkallah, MDj,
- Sylvie Levesque, MSck,
- Anthony S.L. Tang, MDe,
- Paul Khairy, MD, PhDa,k,
- for the CIRCA-DOSE Study Investigators
- aMontreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
- bHeart Rhythm Services, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- cDepartment of Medicine, Southlake Regional Health Center, Newmarket, Ontario, Canada
- dUniversité Laval, Quebec City, Quebec, Canada
- eDepartment of Medicine, University of Western Ontario, London, Ontario, Canada
- fDepartment of Medicine, Royal Jubilee Hospital, Victoria, British Columbia, Canada
- gDepartment of Medicine, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
- hDepartment of Medicine, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
- iDepartment of Medicine, St. Boniface Hospital, Winnipeg, Manitoba, Canada
- jDepartment of Medicine, University of Calgary, Calgary, Alberta, Canada
- kMontreal Health Innovations Coordinating Centre, Montreal, Québec, Canada
- ↵∗Address for correspondence:
Dr. Jason G. Andrade, Heart Rhythm Services, Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, British Columbia V5Z 1M9, Canada.
Objectives This study evaluated the impact of contact force–guided radiofrequency ablation versus cryoballoon ablation on quality of life and health care utilization.
Background Traditional outcome parameters, such as arrhythmia-free survival, are insufficient to evaluate the clinical impact of atrial fibrillation (AF), as it fails to the capture patient- and health system–level differences in treatment approaches.
Methods The CIRCA-DOSE (Cryoballoon Vs. Contact-Force Atrial Fibrillation Ablation) study randomly assigned 346 patients with drug-refractory paroxysmal AF to contact force–guided radiofrequency or cryoballoon ablation. Health-related quality-of-life (HRQOL) was assessed at baseline, and at 6 and 12 months post-ablation using a disease-specific and generic HRQOL instruments. Health care utilization (hospitalization, emergency department visits, and cardioversion) and antiarrhythmic drug use for the 12 months preceding ablation was compared with the 12 months following ablation.
Results Disease-specific and generic HRQOL was moderately to severely impaired at baseline and improved significantly at 6 and 12 months of follow-up (median improvement in AFEQT [Atrial Fibrillation Effect on QualiTy of Life] score 32.4 [interquartile range: 17.7 to 48.9]). When compared with the 12 months pre-ablation, the proportion and absolute number of cardioversions decreased significantly (41.1% vs. 10.1% of patients, 137 vs. 35 events; p < 0.0001). Similar significant reductions in emergency department visits (66.7% vs. 25.1% of patients, 224 vs. 87 events; p < 0.0001), and hospitalizations (25.5% vs. 14.5% of patients, 86 vs. 50 events; p < 0.001) were observed. There were no significant differences between randomized groups.
Conclusions In this multicenter randomized trial, catheter ablation with advanced-generation technologies resulted in a significant improvement in HRQOL and a significant reduction in health care utilization in the year following AF ablation. (Cryoballoon vs. Irrigated Radiofrequency Catheter Ablation [CIRCA-DOSE]; NCT01913522)
The CIRCA-DOSE study was funded by a peer-reviewed grant from the Heart and Stroke Foundation of Canada (grant number G-13-0003121), with additional financial support from Medtronic, and the Heart Rhythm Services at the University of British Columbia. Drs. Andrade and Deyell are supported by a Michael Smith Foundation for Health Research Scholar Award. Dr. Khairy is supported by a research chair in electrophysiology and congenital heart disease. Dr. Andrade has received grant support from Medtronic and Baylis; and has received personal fees from Medtronic and Biosense Webster. Dr. Macle has received personal fees from Medtronic, St. Jude Medical/Abbott, and Biosense Webster; and has received grant support from St. Jude Medical/Abbott and Biosense Webster. Dr. Verma has received grant support from Medtronic, Biosense Webster, and Bayer; has received personal fees from Medtronic and Biosense Webster; and served on the advisory board for Medtronic and Boston Scientific. Dr. Deyell has received grant support from Biosense Webster; and has received honoraria from Biosense Webster and Medtronic. Dr. Dubuc has received grants and personal fees from Medtronic. Dr. Leong-Sit has received personal fees from Medtronic, Baylis, and Biosense Webster. Dr. Roux has served on the Speakers Bureau and advisory board for Biosense Webster. Dr. Sapp has received grant support from Biosense Webster and St. Jude Medical/Abbott; and has received speaker honoraria from Medtronic and Biosense Webster. Dr. Tang has received grant support from Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Isabel Deisenhofer, MD, served as Guest Editor for this paper.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received February 3, 2020.
- Revision received April 9, 2020.
- Accepted April 13, 2020.
- 2020 American College of Cardiology Foundation
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