Conduction system pacing using electro-anatomical mapping-guided system vs. fluoroscopy: a systematic review, meta-analysis and economic evaluation
IntroductionElectro-anatomical mapping (EAM) system has been shown as an alternative procedure to fluoroscopy for conduction system pacing (CSP) in patients with severe bradyarrhythmia, however its beneficial and harmful effects has not been assessed in a systematic review (SR). We sought to assess...
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Frontiers Media S.A.
2025-01-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2024.1519127/full |
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| author | Beatriz León-Salas Beatriz León-Salas Beatriz León-Salas Beatriz León-Salas Diego Infante-Ventura Diego Infante-Ventura Diego Infante-Ventura Aránzazu Hernández-Yumar Aránzazu Hernández-Yumar Aránzazu Hernández-Yumar Renata Linertová Renata Linertová Renata Linertová Renata Linertová Estefanía Herrera-Ramos Estefanía Herrera-Ramos Estefanía Herrera-Ramos Estefanía Herrera-Ramos Alezandra Torres-Castaño Alezandra Torres-Castaño Alezandra Torres-Castaño Alezandra Torres-Castaño Himar González-Pacheco Himar González-Pacheco Himar González-Pacheco Himar González-Pacheco Analía Abt-Sacks Analía Abt-Sacks Analía Abt-Sacks Analía Abt-Sacks Javier García-García Raúl Quirós-López Raúl Quirós-López María M. Trujillo-Martín María M. Trujillo-Martín María M. Trujillo-Martín María M. Trujillo-Martín |
| author_facet | Beatriz León-Salas Beatriz León-Salas Beatriz León-Salas Beatriz León-Salas Diego Infante-Ventura Diego Infante-Ventura Diego Infante-Ventura Aránzazu Hernández-Yumar Aránzazu Hernández-Yumar Aránzazu Hernández-Yumar Renata Linertová Renata Linertová Renata Linertová Renata Linertová Estefanía Herrera-Ramos Estefanía Herrera-Ramos Estefanía Herrera-Ramos Estefanía Herrera-Ramos Alezandra Torres-Castaño Alezandra Torres-Castaño Alezandra Torres-Castaño Alezandra Torres-Castaño Himar González-Pacheco Himar González-Pacheco Himar González-Pacheco Himar González-Pacheco Analía Abt-Sacks Analía Abt-Sacks Analía Abt-Sacks Analía Abt-Sacks Javier García-García Raúl Quirós-López Raúl Quirós-López María M. Trujillo-Martín María M. Trujillo-Martín María M. Trujillo-Martín María M. Trujillo-Martín |
| author_sort | Beatriz León-Salas |
| collection | DOAJ |
| description | IntroductionElectro-anatomical mapping (EAM) system has been shown as an alternative procedure to fluoroscopy for conduction system pacing (CSP) in patients with severe bradyarrhythmia, however its beneficial and harmful effects has not been assessed in a systematic review (SR). We sought to assess their safety, effectiveness and cost-effectiveness.MethodsA SR of the available scientific literature was conducted on the safety, effectiveness, and cost-effectiveness of CSP using EAM system versus fluoroscopy in patients with severe bradyarrhythmia. A partial economic evaluation was carried out to compare the costs of both strategies from the perspective of the Spanish National Health System. A budget impact analysis was also conducted with a five-year horizon.ResultsSeven comparative observational studies (N = 231), analyzing the use of EAM versus fluoroscopy were selected. Statistically significant differences were observed in total fluoroscopy time: −9.87 minutes (95%CI:−14.20, −5.53, p < 0.01; I2 = 95%; k = 7; n = 231); His-lead fluoroscopic time: −8.08 minutes (95%CI:−10.36, −5.81, p < 0.01; I2 = 0%; k = 2; n = 50); and His-lead radiation dose: −17.21 mGy (95%CI:−24.08, −10.34, p < 0.01; k = 1; n = 20). No differences in total fluoroscopy dose, successful procedure or safety were found. The use of EAM represents an increase of EUR 1397.81 per patient and a net budget impact of EUR 1.63 million.DiscussionEAM is a valuable alternative for patients who should not be exposed to ionizing radiation with similar effectiveness and safety than fluoroscopy. However, the inclusion of EAM systems, for the indication under study, in routine clinical practice would mean an increase in costs for the Spanish National Health System.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=421072, identifier (CRD42023421072). |
| format | Article |
| id | doaj-art-8552e14af9554f1bad68ddef479ad949 |
| institution | Kabale University |
| issn | 2297-055X |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj-art-8552e14af9554f1bad68ddef479ad9492025-01-22T16:32:53ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2025-01-011110.3389/fcvm.2024.15191271519127Conduction system pacing using electro-anatomical mapping-guided system vs. fluoroscopy: a systematic review, meta-analysis and economic evaluationBeatriz León-Salas0Beatriz León-Salas1Beatriz León-Salas2Beatriz León-Salas3Diego Infante-Ventura4Diego Infante-Ventura5Diego Infante-Ventura6Aránzazu Hernández-Yumar7Aránzazu Hernández-Yumar8Aránzazu Hernández-Yumar9Renata Linertová10Renata Linertová11Renata Linertová12Renata Linertová13Estefanía Herrera-Ramos14Estefanía Herrera-Ramos15Estefanía Herrera-Ramos16Estefanía Herrera-Ramos17Alezandra Torres-Castaño18Alezandra Torres-Castaño19Alezandra Torres-Castaño20Alezandra Torres-Castaño21Himar González-Pacheco22Himar González-Pacheco23Himar González-Pacheco24Himar González-Pacheco25Analía Abt-Sacks26Analía Abt-Sacks27Analía Abt-Sacks28Analía Abt-Sacks29Javier García-García30Raúl Quirós-López31Raúl Quirós-López32María M. Trujillo-Martín33María M. Trujillo-Martín34María M. Trujillo-Martín35María M. Trujillo-Martín36Canary Islands Health Research Institute Foundation (FIISC), Santa Cruz de Tenerife, SpainEvaluation Unit (SESCS), Canary Islands Health Service (SCS), Santa Cruz de Tenerife, SpainSpanish Network of Agencies for Health Technology Assessment for the National Health Service (RedETS), Madrid, SpainResearch Network on Chronicity, Primary Care, and Health Promotion (RICAPPS), Carlos III Health Institute (Instituto de Salud Carlos III), Madrid, SpainCanary Islands Health Research Institute Foundation (FIISC), Santa Cruz de Tenerife, SpainEvaluation Unit (SESCS), Canary Islands Health Service (SCS), Santa Cruz de Tenerife, SpainSpanish Network of Agencies for Health Technology Assessment for the National Health Service (RedETS), Madrid, SpainCanary Islands Health Research Institute Foundation (FIISC), Santa Cruz de Tenerife, SpainEvaluation Unit (SESCS), Canary Islands Health Service (SCS), Santa Cruz de Tenerife, SpainSpanish Network of Agencies for Health Technology Assessment for the National Health Service (RedETS), Madrid, SpainCanary Islands Health Research Institute Foundation (FIISC), Santa Cruz de Tenerife, SpainEvaluation Unit (SESCS), Canary Islands Health Service (SCS), Santa Cruz de Tenerife, SpainSpanish Network of Agencies for Health Technology Assessment for the National Health Service (RedETS), Madrid, SpainResearch Network on Chronicity, Primary Care, and Health Promotion (RICAPPS), Carlos III Health Institute (Instituto de Salud Carlos III), Madrid, SpainCanary Islands Health Research Institute Foundation (FIISC), Santa Cruz de Tenerife, SpainEvaluation Unit (SESCS), Canary Islands Health Service (SCS), Santa Cruz de Tenerife, SpainSpanish Network of Agencies for Health Technology Assessment for the National Health Service (RedETS), Madrid, SpainResearch Network on Chronicity, Primary Care, and Health Promotion (RICAPPS), Carlos III Health Institute (Instituto de Salud Carlos III), Madrid, SpainCanary Islands Health Research Institute Foundation (FIISC), Santa Cruz de Tenerife, SpainEvaluation Unit (SESCS), Canary Islands Health Service (SCS), Santa Cruz de Tenerife, SpainSpanish Network of Agencies for Health Technology Assessment for the National Health Service (RedETS), Madrid, SpainResearch Network on Chronicity, Primary Care, and Health Promotion (RICAPPS), Carlos III Health Institute (Instituto de Salud Carlos III), Madrid, SpainCanary Islands Health Research Institute Foundation (FIISC), Santa Cruz de Tenerife, SpainEvaluation Unit (SESCS), Canary Islands Health Service (SCS), Santa Cruz de Tenerife, SpainSpanish Network of Agencies for Health Technology Assessment for the National Health Service (RedETS), Madrid, SpainResearch Network on Chronicity, Primary Care, and Health Promotion (RICAPPS), Carlos III Health Institute (Instituto de Salud Carlos III), Madrid, SpainCanary Islands Health Research Institute Foundation (FIISC), Santa Cruz de Tenerife, SpainEvaluation Unit (SESCS), Canary Islands Health Service (SCS), Santa Cruz de Tenerife, SpainSpanish Network of Agencies for Health Technology Assessment for the National Health Service (RedETS), Madrid, SpainResearch Network on Chronicity, Primary Care, and Health Promotion (RICAPPS), Carlos III Health Institute (Instituto de Salud Carlos III), Madrid, SpainQuality and Patient Safety Unit, Nuestra Señora de Candelaria University Hospital, Santa Cruz de Tenerife, SpainResearch Network on Chronicity, Primary Care, and Health Promotion (RICAPPS), Carlos III Health Institute (Instituto de Salud Carlos III), Madrid, SpainInternal Medicine Unit, University Hospital Costa del Sol, Málaga, SpainCanary Islands Health Research Institute Foundation (FIISC), Santa Cruz de Tenerife, SpainEvaluation Unit (SESCS), Canary Islands Health Service (SCS), Santa Cruz de Tenerife, SpainSpanish Network of Agencies for Health Technology Assessment for the National Health Service (RedETS), Madrid, SpainResearch Network on Chronicity, Primary Care, and Health Promotion (RICAPPS), Carlos III Health Institute (Instituto de Salud Carlos III), Madrid, SpainIntroductionElectro-anatomical mapping (EAM) system has been shown as an alternative procedure to fluoroscopy for conduction system pacing (CSP) in patients with severe bradyarrhythmia, however its beneficial and harmful effects has not been assessed in a systematic review (SR). We sought to assess their safety, effectiveness and cost-effectiveness.MethodsA SR of the available scientific literature was conducted on the safety, effectiveness, and cost-effectiveness of CSP using EAM system versus fluoroscopy in patients with severe bradyarrhythmia. A partial economic evaluation was carried out to compare the costs of both strategies from the perspective of the Spanish National Health System. A budget impact analysis was also conducted with a five-year horizon.ResultsSeven comparative observational studies (N = 231), analyzing the use of EAM versus fluoroscopy were selected. Statistically significant differences were observed in total fluoroscopy time: −9.87 minutes (95%CI:−14.20, −5.53, p < 0.01; I2 = 95%; k = 7; n = 231); His-lead fluoroscopic time: −8.08 minutes (95%CI:−10.36, −5.81, p < 0.01; I2 = 0%; k = 2; n = 50); and His-lead radiation dose: −17.21 mGy (95%CI:−24.08, −10.34, p < 0.01; k = 1; n = 20). No differences in total fluoroscopy dose, successful procedure or safety were found. The use of EAM represents an increase of EUR 1397.81 per patient and a net budget impact of EUR 1.63 million.DiscussionEAM is a valuable alternative for patients who should not be exposed to ionizing radiation with similar effectiveness and safety than fluoroscopy. However, the inclusion of EAM systems, for the indication under study, in routine clinical practice would mean an increase in costs for the Spanish National Health System.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=421072, identifier (CRD42023421072).https://www.frontiersin.org/articles/10.3389/fcvm.2024.1519127/fullbradycardiasconduction system pacingelectro-anatomical mappingfluoroscopyHis bundle pacingleft bundle pacing |
| spellingShingle | Beatriz León-Salas Beatriz León-Salas Beatriz León-Salas Beatriz León-Salas Diego Infante-Ventura Diego Infante-Ventura Diego Infante-Ventura Aránzazu Hernández-Yumar Aránzazu Hernández-Yumar Aránzazu Hernández-Yumar Renata Linertová Renata Linertová Renata Linertová Renata Linertová Estefanía Herrera-Ramos Estefanía Herrera-Ramos Estefanía Herrera-Ramos Estefanía Herrera-Ramos Alezandra Torres-Castaño Alezandra Torres-Castaño Alezandra Torres-Castaño Alezandra Torres-Castaño Himar González-Pacheco Himar González-Pacheco Himar González-Pacheco Himar González-Pacheco Analía Abt-Sacks Analía Abt-Sacks Analía Abt-Sacks Analía Abt-Sacks Javier García-García Raúl Quirós-López Raúl Quirós-López María M. Trujillo-Martín María M. Trujillo-Martín María M. Trujillo-Martín María M. Trujillo-Martín Conduction system pacing using electro-anatomical mapping-guided system vs. fluoroscopy: a systematic review, meta-analysis and economic evaluation Frontiers in Cardiovascular Medicine bradycardias conduction system pacing electro-anatomical mapping fluoroscopy His bundle pacing left bundle pacing |
| title | Conduction system pacing using electro-anatomical mapping-guided system vs. fluoroscopy: a systematic review, meta-analysis and economic evaluation |
| title_full | Conduction system pacing using electro-anatomical mapping-guided system vs. fluoroscopy: a systematic review, meta-analysis and economic evaluation |
| title_fullStr | Conduction system pacing using electro-anatomical mapping-guided system vs. fluoroscopy: a systematic review, meta-analysis and economic evaluation |
| title_full_unstemmed | Conduction system pacing using electro-anatomical mapping-guided system vs. fluoroscopy: a systematic review, meta-analysis and economic evaluation |
| title_short | Conduction system pacing using electro-anatomical mapping-guided system vs. fluoroscopy: a systematic review, meta-analysis and economic evaluation |
| title_sort | conduction system pacing using electro anatomical mapping guided system vs fluoroscopy a systematic review meta analysis and economic evaluation |
| topic | bradycardias conduction system pacing electro-anatomical mapping fluoroscopy His bundle pacing left bundle pacing |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2024.1519127/full |
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