{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T20:56:10Z","timestamp":1793134570065,"version":"4.5.0"},"reference-count":62,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T00:00:00Z","timestamp":1769731200000},"content-version":"unspecified","delay-in-days":29,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Medtronic"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2026,1,14]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Persistent atrial fibrillation (PersAF) presents a significant clinical and economic burden and is associated with poorer outcomes after catheter ablation compared with paroxysmal atrial fibrillation (AF). Pulsed field ablation (PFA) has emerged as a new form of energy modality for AF treatment. Sphere-9 is a novel dual-energy large-focal lattice tip (LFLT) catheter that is also capable of high-density mapping. The study aims to evaluate the cost-effectiveness of Sphere-9 catheter versus conventional radiofrequency (RF ablation for the treatment of PersAF in the English National Health Service (NHS) setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Individual patient data from the SPHERE Per-AF randomised controlled trial were used to estimate efficacy, safety and resource utilisation parameters in symptomatic PersAF patients. The cost-effectiveness model consisted of a hybrid decision tree (1-year time horizon) and a Markov model with 3-month cycle length (lifetime time horizon, 40 years) and was developed from the perspective of the English NHS. Unit costs were derived from the National Institute for Health and Care Excellence (NICE) clinical guideline for AF diagnosis and management (NG196) and NHS national cost collection data. Health benefits were expressed in quality-adjusted life years (QALYs), and all benefits and costs were discounted at 3.5% per year in line with NICE requirements.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>LFLT ablation was found to be dominant compared with RF, since it was less costly and it produced greater health outcomes. LFLT was associated with an average cost of \u00a315 433 and 8.26 QALYs per patient, compared with \u00a320 861 and 8.20 QALYs for RF ablation. Results remained robust across all sensitivity and scenario analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>The Sphere-9 catheter is a cost-saving strategy for treating patients with PersAF compared with conventional RF ablation. Given the growing burden of AF and limited healthcare resources, Sphere-9 presents a valuable option for improving patient outcomes while optimising NHS resource allocation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/openhrt-2025-003770","type":"journal-article","created":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T11:30:13Z","timestamp":1769772613000},"page":"e003770","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Economic evaluation of a novel dual-energy, large focal lattice-tip catheter versus conventional contact-force sensing radiofrequency catheter, for persistent atrial fibrillation ablation, from the English National Health Service perspective"],"prefix":"10.1136","volume":"13","clinical-trial-number":[{"clinical-trial-number":"nct05120193","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8246-9974","authenticated-orcid":false,"given":"Greg","family":"Mellor","sequence":"first","affiliation":[{"name":"Royal Papworth Hospital, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivek","family":"Reddy","sequence":"additional","affiliation":[{"name":"Helmsley Electrophysiology Centre, Mount Sinai Fuster Heart Hospital, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prapa","family":"Kanagaratnam","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute Imperial College, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rowan","family":"Iskandar","sequence":"additional","affiliation":[{"name":"Medtronic International Trading S\u00e0rl, Tolochenaz, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleni","family":"Ismyrloglou","sequence":"additional","affiliation":[{"name":"Medtronic Bakken Research Center BV, Maastricht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Waruiru","family":"Mburu","sequence":"additional","affiliation":[{"name":"Medtronic Inc, Minneapolis, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maxim","family":"Souter","sequence":"additional","affiliation":[{"name":"Medtronic Ltd, Watford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elad","family":"Anter","sequence":"additional","affiliation":[{"name":"Shamir Medical Center, Be'er Ya'Akov, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,1,30]]},"reference":[{"key":"2026013003300799000_13.1.e003770.1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehz278"},{"key":"2026013003300799000_13.1.e003770.2","doi-asserted-by":"publisher","DOI":"10.1177\/1747493019897870"},{"key":"2026013003300799000_13.1.e003770.3","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/eht280"},{"key":"2026013003300799000_13.1.e003770.4","doi-asserted-by":"crossref","first-page":"110","DOI":"10.33590\/emjcardiol\/10310292","article-title":"A Review of the Burden of Atrial Fibrillation: Understanding the Impact of the New Millennium Epidemic across Europe","volume":"27","author":"Velleca","year":"2019","journal-title":"EMJ Cardiol"},{"key":"2026013003300799000_13.1.e003770.5","unstructured":"Evans T . 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