1. AF Ablation Liverpool and England data Derick Todd Clinical Lead EP, Devices & ICC Liverpool Heart & Chest Hospital

2. Background Variation in provision – for AF ablation 5-fold across UK NICOR data for ablation last published for 2013-14 9 th year / 60 centres New dataset started in April 2014 – to better understand ablation work, especially AF

3. EP Consultant + Ablation Numbers LHCH

4. UK Ablation Numbers 2007-2013

5. Ablation numbers - Geographical Variation 20102013-14

6. Ablation data - Geographical Variation

7. Quality of Care - Geographical Variation

8. AF ablation - Geographical Variation 20102013-14

9. AF Ablation Rates - European data

10. Referral Issues or Funding Issues A low provision of ablation for AF may relate to under-referral threshold for ablation funding Referral issues can be assessed by ratio of AF ablation to AVNRT ablation. The 6 largest English centres have rates of 2-3 i.e. 2-3 x as many AF ablations as AVNRT University Hospital South Wales – ratio = 0.74

11. AF Impact – Quality of Life SF-36 9 AF patients ~1 SD lower than healthy volunteers 9. Dorian P et al (2000) The impairment of health-related quality of life in patients with intermittent atrial fibrillation: implications for the assessment of investigational therapy. J Am Coll Cardiol 36:1303-1309

12. Referral Issues or Funding Issues Cost of AF ablation (EA29Z) - £3505 (elective) Devices excluded – cost approx. £3000 Total £6500 per case LHCH service – 600 per annum = £3.9m

13. Cost effectiveness?

15. Ablation – the future in England (& Wales) NICE guidance encourages referral for ablation NHS England conscious of ablation costs – reviewing selection criteria Possible link to PROMS in future (PROMS – patient reported outcome measures)