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Ablation by three-dimensional electroanatomical mapping versus anti-arrhythmic drug therapy: a cost-utility analysis in the treatment of idiopathic ventricular arrhythmias

BMC Cardiovascular Disorders volume 25, Article number: 243 (2025) Cite this article

Abstract

Aim

To assess the cost-utility of ablation guided by three-dimensional electroanatomical mapping (3DEAM) with antiarrhythmic drug (AAD) therapy in the management of patients with idiopathic ventricular arrhythmias (IVA) at a highly specialized cardiovascular center in Peru.

Methods

A cost-utility economic evaluation was conducted in a public institution involving patients diagnosed with IVAs between 2017 and 2022. The analysis included projections adjusted according to life expectancy. Cost analysis was performed from the payer’s perspective (public health insurance) using the macro-cost estimation methodology and applying a 9.6% discount rate. Utility values were derived from the SF-36 questionnaire, facilitating the calculation of average quality-adjusted life years (QALYs) for each group. Cost-utility analysis was executed by determining the Average Cost-Utility Ratio (ACUR) and the Incremental Cost-Utility Ratio (ICUR) against the cost-effectiveness threshold set for Peru.

Results

The study included 52 patients with IVAs, with 34 undergoing 3DEAM ablation and 18 receiving AAD therapy. The recurrence rate (14.7% vs. 50%, p = 0.010) and complication/adverse event rate (0% vs. 22.2%, p = 0.011) were lower in the 3DEAM ablation group. Over a four-year time horizon, 3DEAM ablation resulted in higher average costs ($7,234.81 vs. $2,136.51), average QALYs (3.30 vs. 2.98), and ACUR ($2,187.26 vs. $716.31) compared to AAD therapy. The calculated ICUR was $15,684.78, which was below the cost-effectiveness threshold for Peru. Extending the analysis to align with life expectancy projections showed that average QALYs were significantly higher in the 3DEAM group (34.25 vs. 14.83) and with a lower ACUR ($230.94 vs. $646.01) and more favorable economic outcomes.

Conclusion

The 3DEAM ablation strategy can be considered cost-utility intervention for treating IVAs in our region. These results are in line with published data on cost-effectiveness of 3DEAM ablations of IVA in developed countries.

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Introduction

Ventricular arrhythmias (VA) present a wide spectrum of clinical manifestations, ranging from extrasystoles to ventricular tachycardias (VT). These can be asymptomatic or present with various symptoms, impacting quality of life and even increasing mortality, especially when associated with structural heart disease [1]. Idiopathic ventricular arrhythmias (IVA) are identified in patients without arrhythmic substrate, that is, the absence of myocardial scar indicating the presence of structural heart disease [2].

In recent decades, catheter ablation using radiofrequency energy and a three dimensional electro anatomical mapping (3DEAM) system has become an important therapeutic alternative [1]. Advances in technologies and the publication of clinical studies have consolidated 3DEAM guided ablation as an effective and safe therapeutic option for both IVA and those VA associated with arrhythmic substrate [3,4,5].

The development of new healthcare technologies can lead to short-term increased costs. However, given the greater efficacy in the management of VA using 3DEAM guided ablation, this approach could be cost-effective in the long term. Worldwide, comprehensive economic evaluation studies in patients with ventricular arrhythmias suggests that 3DEAM guided ablation is more cost-effective compared to amiodarone in the long term [6], and more efficient than escalating AAD therapy [7].

The first Latin American registry of catheter ablation of cardiac arrhythmias, published in 2015, revealed that 67% of specialized centers in the region performed ablation of IVA [8]. In Peru, the National Cardiovascular Institute (INCOR) implemented technology and trained personnel to perform 3DEAM guided ablations since 2017. The progressive incorporation of this technology at INCOR’s cardiac arrhythmia unit has made it possible to achieve levels of efficacy and safety comparable to those obtained in specialized centers in our region in the management of complex cardiac arrhythmias [9]. From 2017 to 2019, the INCOR’s arrhythmia unit performed 3DEAM guided ablations for various types of arrhythmias, recording a total of 123 patients, of which 36 corresponded to IVA [9].

Research on cost-utility is a valuable tool for healthcare services, supporting decisions for fund allocation towards highly efficient procedures. For this reason, we performed a cost-utility analysis comparing therapeutic strategies for the management of IVA (3DEAM guided ablations versus AAD therapy).

Methods

Design

Cost-utility economic evaluation of 3DEAM ablations versus AAD therapy for patients with IVA treated at INCOR, a highly specialized cardiovascular institute belonging to Peru’s public social health insurance system (EsSalud).

Population

We studied all patients diagnosed with idiopathic ventricular arrhythmias treated by 3DEAM guided ablation or AAD therapy at INCOR, between 2017 and 2019. A total of 34 patients were included in the 3DEAM group and 18 patients in the AAD group.

Inclusion criteria: Patients with symptomatic IVA whose diagnosis and type of treatment were defined at INCOR– EsSalud, patients with IVA as the primary diagnosis, treated with either 3DEAM guided ablation or AAD therapy, patients with idiopathic ventricular arrhythmias characterized by very frequent ventricular extrasystoles with an arrhythmic burden greater than 5% or recurrent ventricular tachycardia with more than three episodes, and patients between 14 and 64 years.

Exclusion criteria: Patients with incomplete clinical history data relevant to the study and those who did not agree to complete the SF-36 quality of life questionnaire.

All 3DEAM-guided ablation procedures were performed using the Carto 3 System (Biosense Webster, Diamond Bar, CA). The standard approach involved detailed electroanatomical mapping of the target chamber, guided by the clinical electrocardiogram of idiopathic premature ventricular contractions (PVCs) or VT, to identify the earliest activation sites. For idiopathic PVCs, the ablation target was the site where the pre-QRS bipolar electrogram preceded the QRS onset by at least − 30 ms, with a QS pattern in the unipolar electrogram. For fascicular VT, the target was either the diastolic potential (P1) in the antegrade limb of the VT circuit or a presystolic fused Purkinje potential at the VT exit if P1 was not recorded.

Mapping and radiofrequency catheter ablation were performed using an 8-Fr deflectable catheter with a 3.5-mm open-irrigated tip (Thermocool SF NAV or Thermocool SmartTouch-SF, Biosense Webster, Diamond Bar, CA) at critical sites of the reentrant VT circuit or the focal PVC origin. The procedure endpoint was defined as non-inducibility of the clinical arrhythmia or its disappearance (or a marked reduction in PVC burden) during an adequate observation period.

Regarding the AAD group, the choice of antiarrhythmic agent was at the discretion of the treating electrophysiologist, considering symptoms, arrhythmia burden, comorbidities, and drug tolerability. Beta-blockers were the most commonly used agents (n = 11, 61.1%), although some patients received Class Ic, III, or IV antiarrhythmics based on clinical needs and contraindications.

Time horizon

The time horizon for the study was defined based on the data collection period from June 2017 to October 2022. Projections were also made according to life expectancy, beginning from the initiation of the intervention for each analysis unit. The costs were adjusted to their present value using the discount rate determined by the institution.

Costs estimation

Direct and indirect health care costs were considered for each treatment strategy. The cost analysis included: 3DEAM guided ablation procedures, AAD therapy, outpatient medical consultations, emergency room and hospital admission visits, complications or adverse effects of the interventions, cardiology evaluations, laboratory tests, and transfer of patients and family members from their place of origin to INCOR, if their place of origin was outside the province of Lima. The macro cost estimation methodology was used. The medical services provided, rates of use/quantities and unit costs were identified to determine the total cost. For the valuation of pharmacological treatments and supplies, the standard cost provided by the finance area of INCOR was used. Expenses assumed by the patient and/or family (out-of-pocket or other expenses) were not considered for this analysis since the economic analysis was carried out from the payer’s perspective (EsSalud public health insurance).

The monetary reference period was the month of December 2022 with an exchange rate of S/3.8478 nuevos soles (PEN) per US dollar (US$/1.0) according to the Central Reserve Bank of Peru, adjusting the values in soles according to the discount rate calculated for the payer institution. Table S1 presents the cost estimation using the macro-cost methodology, detailing all the services provided, the unit price in dollars of each medical service and the rate of use or quantity of each service provided based on the collection of real data according to the intervention group. The service with the highest unit price recorded was 3DEAM guided ablation, which cost 6,047.94 USD. Table S2 presents the average dollar costs for the eight categories of services provided, with an average follow-up period of 4 years. The average cost was 7,234.81 USD for 3DEAM guided ablation and 2,136.51 USD for AAD therapy.

Discount rate

To calculate the net present value of the costs obtained, the most relevant discount rate for the institution was used, using different alternatives such as the weighted average cost of capital (WACC) for EsSalud, the National Institute for Health and Care Excellence (NICE) and the social discount rate established by the Ministry of Economy and Finance (MEF) in Peru.

The institution’s WACC was used, because it is the rate at which the paying institution obtains financing, while the rate established by NICE is a recommended rate for developed country settings that have lower interest rates [10], and the MEF discount rate is a recommended rate for public sector social investments [11]. Rate of the WACC is 9.6%. It was calculated using the CAPM methodology, which weights the implicit cost of the debt that generates interests to EsSalud of 9.33%, and the cost of capital rising to 9.67%. The implicit cost of debt is obtained by weighting the two interest-bearing obligations of EsSalud for two public-private partnerships with which it has outstanding obligations in the amounts of 158,815,255 soles with an interest rate of 9.7% and 158,815,255 soles with an interest rate of 8.94% (source: EsSalud). The cost of capital was determined based on the risk-free rate of U.S. Treasury bonds, which amounts to 3.015%, a stock market premium with an interest rate of 4.64% and the country risk differential, which amounts to an interest rate of 1.43%.

Procedures

After selecting the patients, we reviewed their medical records to collect necessary information. The second stage, conducted between January and March 2023, involved administering the Spanish version of the SF-36v2™ Health Survey [12], through a telephone interview. This questionnaire includes 36 multiple-choice questions. Its completion yields a total standardized score ranging from 0 to 100, where 0 indicates no quality of life and 100 represents the highest quality of life. This instrument has been validated for use in our country [13].

Unit costs for the health services received by the participants were obtained from our institution finance department, based on cost structures validated by both the electrophysiology and finance units of INCOR - EsSalud.

Data analysis

Statistical analysis was performed using the Stata v15 statistical package (StataCorp, TX, USA). We included univariate analysis using measures of central tendency, measures of dispersion, absolute frequencies and relative frequencies. For the comparison of normally distributed means, we used the Student’s t-test and the Mann Whitney U test in the case of non-normal distributions.

To calculate the average costs in both groups, we considered the costs per unit of use, unit of time and the accounting number (number of times the unit is repeated). The estimated costs were updated using the discount rate calculated for the institution of 9.6%.

To estimate the years of life associated with each intervention, life expectancy in Peru was taken according to data from the National Institute of Statistics and Informatics. This reflects the expected average life expectancy in the country, which is 79.8 years for women and 74.5 years for men for the period 2020–2025 [14].

Utility was based on the calculation of the average total standardized score obtained from the application of the SF-26 v2 divided by 100. The utility obtained in each group was multiplied by the years of life registered according to the time horizon considered for each patient, obtaining the quality-adjusted life years (QALY) and then calculating the average QALY in each group according to the intervention.

To obtain the cost utility ratio (CUR), the average total cost was divided by the average QALYs obtained for each intervention. To obtain the Incremental Cost Utility Ratio (ICUR), the difference in costs was divided by the difference in QALYs for both procedures in order to compare it with the established thresholds.

The univariate sensitivity analysis of the variables that had the greatest impact on the result and the multivariate sensitivity analysis were carried out, making it necessary to construct three scenarios: the most probable, the pessimistic and the optimistic.

The cost-effectiveness threshold established in this study for Peru was up to 3 times the GDP per capita, equivalent to US$ 21,377.4, considering a GDP per capita in 2022 of US$ 7,125.8 (source: World Bank national accounts data and OECD national accounts data files), based on the recommendations of the report of the Commission on Macroeconomics and Health of the World Health Organization.

Ethics

The present study was approved by the Ethics Committee of INCOR. No variables that may identify the patients were collected. All participants voluntarily agreed to participate in the present study by giving their consent for the collection and analysis of the data present in their clinical history and questionnaire of the Spanish version of the SF-36v2 Health Questionnaire applied. In the case of minors, a conversation was initiated with the parent or guardian, who provided their consent, followed by the assent of the minor.

Results

Of the 52 patients with idiopathic ventricular arrhythmia included in this study, 65.4% (n = 34) were in the 3DEAM ablation group and 34.6% (n = 18) in the AAD medication group. The median age was 49 years (IQR: 24.5–60). A total of 55.8% were female, and 44.2% resided in a province other than Lima. Post-intervention, most patients were asymptomatic (n = 28; 53.8%). Among those who reported at least one cardiovascular symptom (n = 24), the most common were palpitations (n = 22; 42.3%), followed by dyspnea (n = 6; 11.5%), chest pain (n = 3; 5.8%), and syncope (n = 1; 1.9%). The median age was lower in the 3DEAM ablation group compared to the antiarrhythmic group (32 vs. 59.5; p = 0.001). The absence of symptoms was higher in the 3DEAM ablation group (80% vs. 0%; p < 0.001). Complications/adverse events were fewer in the 3DEAM ablation group (0% vs. 22.2%, p = 0.011). The recurrence rate was lower in the 3DEAM ablation group (14.7% vs. 50.0%, p = 0.010), and the median number of outpatient visits was fewer (3 vs. 14.5; p < 0.001) (Table 1).

Table 1 Clinical and epidemiological characteristics of the included patients (n = 52)
Full size table

Regarding costs, for the eight categories of services provided, based solely on actual data collection, the average cost per patient in the AAD group was $2,136.51 compared to $7,234.81 in the 3DEAM ablation group. Based on the collection of data added to the cost projections according to life expectancy (79.8 years for women and 74.5 for men in the period 2020–2025), the average cost per patient in the group of antiarrhythmics was $9,581.34, compared to $7,910.12 in the 3DEAM ablation group. (Table 2).

Table 2 Analysis of total average cost based on the collection of real data and its projection according to the life expectancy of patients according to intervention group
Full size table

The total Quality-Adjusted Life Years (QALYs) for a 4-year time horizon were 112.42 for the 3D ablation group and 53.69 for the antiarrhythmic group. The average QALYs calculated were 3.3 and 2.98, respectively. We used the average cost-utility ratio (ACUR) for each group, calculated by dividing the average cost by the average QALY. In the 3DEAM ablation group, an ACUR of $2,187.26 per QALY gained was obtained, and in the antiarrhythmic group, an ACUR of $716.31. Although more expensive, 3DEAM ablation showed better results, with the Incremental Cost-Utility Ratio (ICUR) being $15,684.78 per QALY, below the WHO threshold of three times the GDP per capita per QALY ($21,377.4 for Peru), indicating that 3DEAM ablation is a cost-effective strategy for managing idiopathic ventricular arrhythmias over a 4-year horizon.

For the time horizon estimated according to life expectancy, the QALYs obtained were 1,164.58 for the 3DEAM ablation group and 266.97 for the AAD group. The average QALYs were 34.25 and 14.83, respectively. In this context, the ACUR in the 3DEAM ablation group was $230.94 per QALY, and in the AAD group, $646.01. This indicates that 3D ablation is more cost-effective than antiarrhythmic therapy for an estimated life expectancy horizon. The calculated ICUR was -$86.05, suggesting savings per QALY gained, positioning 3D ablation as a cost-effective and efficient strategy (Table 3).

Table 3 Mean cost-utility ratio and incremental cost-utility ratio for each intervention group in patients with idiopathic ventricular arrhythmias from the National cardiovascular Institute INCOR EsSalud
Full size table

In the univariate sensitivity analysis, considering a hypothetical scenario where the ACUR is equal in both intervention groups for a 4-year horizon, drastic adjustments in costs would be necessary: the cost of 3DEAM ablation would have to be reduced to $1,576.98, while the cost of drugs would need to increase by 1832%, the transfer from the province by 806%, cardiological studies by 781%, and outpatient consultation to $347.03. For a time horizon based on life expectancy, the required adjustments would be equally extreme but in opposite directions: the cost of 3DEAM ablation would need to increase to $19,112.71, the cost of drugs decrease by 577%, the cost of transfer from the province by 187%, cardiology studies by 217%, and outpatient care decrease to -$180.18. These changes are not feasible, indicating that there is no realistic scenario in which the ACUR of both interventions could be equalized (Table 4).

Table 4 Sensitivity analysis for each variable considering an identical ACUR for each intervention group
Full size table

In the sensitivity analysis considering multiple variables, we included the five most influential variables in total spending across three scenarios: an optimistic scenario with no cost variation, a more likely scenario with cost variations based on inflation of 5 to 10%, and a pessimistic scenario with cost variations based on inflation of 10 to 25%. In none of these scenarios, neither for a 4-year horizon nor their estimation according to life expectancy, was the difference between the ACURs of the two interventions significantly shortened (Table 5).

Table 5 Multivariate sensitivity analysis considering different scenarios in a time horizon of 4 years and according to life expectancy
Full size table

Regarding quality of life, a mean total score of 85.1 ± 13.5 was observed in the 3DEAM ablation group compared to the AAD group, which obtained a mean score of 68.4 ± 15.9 (p < 0.001). Analysis of the SF-36 revealed statistically significant differences in 6 of the 8 components between the two groups, with notable improvements in physical function, physical role, general health, vitality, emotional role, and mental health in the ablation group. No significant differences were found in the components of bodily pain and social function (Table S3).

Discussion

Our findings suggest that 3DEAM ablation is both more effective and safer compared to AAD therapy for managing idiopathic ventricular arrhythmias. We observed significant clinical improvements, lower recurrence rates, and fewer complications/adverse effects with this intervention. Specifically, the recurrence rate and complications were significantly lower in the 3DEAM ablation group (14.7% and 0.0%, respectively) compared to the AAD group (50.0% and 22.2%). These results are supported by similar findings in the literature. A systematic review involving 1113 patients across five studies, reported a superiority of 3DEAM ablation over AAD therapy in reducing arrhythmic load and recurrence, as well as in minimizing complications and adverse effects [15]. Furthermore, a retrospective multicenter study encompassing 1185 patients from the United States, Canada, and Germany reported an acute success rate of 84%, a recurrence-free survival of 71%, and a complication rate of 5.2% [16].

In our institutional context at INCOR, the developed expertise in 3DEAM ablation has led to an early success rate of 95.5%, which likely enhances the intervention’s observed benefits in our study [9]. Idiopathic VA generally carry a benign prognosis, with life expectancy aligning closely with that of the general population [17]. For the period 2020–2025 in Peru, life expectancy was projected at 79.8 years for women and 74.5 for men [14]. This facilitated the estimation of expenditures for both groups based on life expectancy projections. The total average costs were notably lower in the 3DEAM ablation group ($7,910.12) compared to the antiarrhythmic group ($9,581.34). Additionally, the 3DEAM ablation group achieved superior clinical outcomes, averaging 34.25 QALYs versus 14.83 QALYs in the AAD group, suggesting that 3DEAM ablation is a cost-effective utility intervention. These findings align with other economic evaluations, such as a Markov model-based study comparing amiodarone and ventricular tachycardia ablation, which demonstrated a higher cost-effectiveness for ablation [6].

Our sensitivity analysis for the univariate model did not reveal any plausible adjustments in the variables with the most substantial impact on the calculated average costs that could equate or reverse the ACUR results for both intervention groups at 4 years and according to life expectancy. Similarly, the multivariate sensitivity analysis did not identify any scenarios that could alter the cost-utility results achieved for both groups over the same periods.

Quality of life, assessed by the Spanish version of the SF-36v2 Health Survey [12], improved significantly among patients in the 3DEAM ablation group. This improvement aligns with multiple clinical studies, such as those by Huang et al., who reported significant quality of life enhancements at 3 and 12 months post-ablation compared to pre-procedure levels, across all survey components [18].

Implications for clinical practice and public health

Our results could aid health system managers in making informed decisions regarding the adoption of innovative health technologies like 3DEAM ablation for the treatment of idiopathic VA. Although 3DEAM ablation is a higher-cost therapeutic strategy compared to antiarrhythmic drugs, its superior cost-utility—apparent both in a 4-year time horizon and over an estimated life expectancy—underscores its potential not only to redefine standard therapeutic approaches but also to significantly enhance the quality of life for patients.

Moreover, evidencing that 3DEAM ablation is a more cost-utility option than AAD therapy, with improvements in quality of life and cost savings, suggests a pivotal opportunity for resource re-allocation within the healthcare system. This could lead to enhanced patient care management and the reallocation of resources for other critical healthcare needs, including invasive treatment of other common arrhythmias such as atrial fibrillation, which has a high prevalence in western society and carries increased morbidity and mortality with a significant expenditure of healthcare resources when not treated appropriately [19, 20].

Furthermore, these findings may significantly shape public health policy by advocating for a proactive approach in managing idiopathic ventricular arrhythmias. This involves embracing new technologies like 3DEAM systems and the necessary supplies to facilitate ablation of complex arrhythmias, as well as investing in specialized training and research to keep the health system at the cutting edge of treatment for these conditions. Implementing these recommendations and policy changes could not only elevate patient care in Peru but also serve as a benchmark for other nations with similar healthcare challenges. However, it is important that any therapeutic decision involving the use of new technologies be grounded in evidence, thus requiring consideration of properly conducted health technology assessments and clinical practice guidelines that guide informed clinical decision-making.

Limitations and strengths

While our findings are promising, certain limitations warrant careful consideration when interpreting the results. This study relies on medical records from our hospital; thus, any undocumented information could potentially skew our findings. Despite our small sample size, we believe these results could cautiously be generalized to other centers or hospitals that frequently receive patient referrals and transfers for management of idiopathic VA, indicating that our findings may be relevant in settings with similar levels of complexity. Costs were estimated based on the INCOR VA management protocol and updated annually using a discount rate specific to our institution, providing a cost approximation relevant to various Peruvian contexts. Additionally, our follow-up period may not fully capture the long-term adverse effects of antiarrhythmic drug therapy, particularly amiodarone. Longer follow-up or prospective registries could provide a more comprehensive assessment of its safety profile and its impact on cost-utility comparisons. Finally, since the groups differ in some clinical characteristics, there could be some bias affecting the effectiveness of the measured outcomes. Further longitudinal cohort with a larger volume of patients may be necessary to confirm our study observations and results.

Conclusion

Our findings suggest that 3DEAM ablation is a potentially cost-utility health technology for managing IVA in our healthcare landscape, considering a 4-year time horizon and a projected life expectancy, with a discount rate of 9.6%. Although it is more costly in the short term, 3DEAM ablation offers better clinical outcomes compared to conventional AAD therapy. The ICUR calculated for 3DEAM ablation over a 4-year time projection is below the cost-effectiveness threshold for Peru, indicating its economically viable in our national public health system. Furthermore, when estimated according to life expectancy, 3DEAM ablation appears to be a less expensive option with better clinical results than AAD treatment, highlighting its long-term effectiveness. Our results are in line with published data from developed countries and highlight the importance of emerging technologies to improve the quality of life and long-term results of patients with IVA in our region.

Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

None.

Funding

Self-funded.

Author information

Authors and Affiliations

  1. Universidad Nacional Mayor de San Marcos, Lima, Peru

    Richard Soto-Becerra, José C. Navarro-Lévano & Teófilo J. Fuentes Rivera Salcedo

  2. Unidad de Arritmias, Instituto Nacional Cardiovascular INCOR, EsSalud, Lima, Peru

    Richard Soto-Becerra, Pio D. Zelaya-Castro & Mario Cabrera-Saldaña

  3. Carrera de Medicina Humana, Universidad Científica del Sur, Lima, Peru

    Diego Chambergo-Michilot & Daniel Fernandez-Guzman

  4. OBEMET Center for Obesity and Metabolic Health, Lima, Peru

    Diego Chambergo-Michilot, Daniel Fernandez-Guzman & Carlos J. Toro-Huamanchumo

  5. Florida Electrophysiology Associates, Atlantis, FL, USA

    Alejandro Jimenez-Restrepo

  6. University of Maryland School of Medicine, Baltimore, MD, USA

    Alejandro Jimenez-Restrepo

  7. Universidad San Ignacio de Loyola, Lima, Peru

    Carlos J. Toro-Huamanchumo

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  1. Richard Soto-Becerra
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Contributions

Conceptualization: RSB; Data curation: RSB; Formal analysis: All authors; Methodology: All authors; Writing– original draft: RSB, PDZC, JCNL, TJFRS, MCS, DCM, DFG; Writing– review & editing: AJR, CJTH. All authors have read and agreed to the published version of the manuscript.

Corresponding authors

Correspondence to Richard Soto-Becerra or Carlos J. Toro-Huamanchumo.

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Ethics approval and consent to participate

The present study was approved by the Ethics Committee of the National Cardiovascular Institute (INCOR). No variables that may identify the patients were collected. All participants voluntarily agreed to participate in the present study by giving their consent for the collection and analysis of the data present in their clinical history and questionnaire of the Spanish version of the SF-36v2 Health Questionnaire applied. In the case of minors, a conversation was initiated with the parent or guardian, who provided their consent, followed by the assent of the minor. All procedures were performed in accordance with relevant guidelines and regulations.

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Not applicable.

Competing interests

The authors declare no competing interests.

Conflict of interest

None to declare.

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Soto-Becerra, R., Zelaya-Castro, P.D., Navarro-Lévano, J.C. et al. Ablation by three-dimensional electroanatomical mapping versus anti-arrhythmic drug therapy: a cost-utility analysis in the treatment of idiopathic ventricular arrhythmias. BMC Cardiovasc Disord 25, 243 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12872-025-04683-y

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  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12872-025-04683-y

Keywords

BMC Cardiovascular Disorders

ISSN: 1471-2261

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