The right recommendations for the wrong reasons?

Abstract

This editorial is endorsed by the Belgium Heart Rhythm Association (BeHRA) and the Belgian Society of Cardiology (BSC), and refers to ‘Effectiveness of catheter ablation of atrial fibrillation in Belgian practice: a cohort analysis on administrative data’ by Van Brabandt et al ., on page 663. The mission of a health technology assessment (HTA) consists of advising public authorities when they have to take decisions on health care and health insurance, in particular concerning new technologies. Health technology assessment reports are based on a comprehensive review of literature and the analysis of national data. These data are interesting because of the large sample size and the absence of reporting bias introduced by selective publication of results from specialized centres. Health technology assessment reports put forward recommendations to the authorities and this can lead to crucial decisions about the reimbursement and potential availability of a technique. Recently, the KCE, the Belgian Health Care Knowledge Centre, published a HTA report on catheter ablation of atrial fibrillation (CA-AF).1,2 Upon the publication of their report (https://kce.fgov.be), the authors issued a press release in which they stated unambiguously: ‘catheter ablation for a benign arrhythmia: less effective than hoped’. In this editorial, we discuss about the legitimacy and the potential implications of this conclusion. Atrial fibrillation is not a benign condition, as it is associated with increased stroke, hospitalization, and death. In younger patients, it can lead to a marked impairment of quality of life (QoL) due to symptoms of palpitations, dyspnoea, and fatigue. From its start, CA-AF has offered the promise to free patients of symptomatic AF.3 Numerous randomized controlled trials (RCTs), performed in young patients with paroxysmal AF, compared a ‘strategy of CA-AF’ (i.e. a policy of initial pulmonary vein isolation with a repeat isolation if appropriate) to antiarrhythmic drugs.4 …