Purpose of review: Atrial fibrillation is a growing public health problem and is associated with an increased risk of comorbidities with enormous socioeconomic implications. This review article focuses on fiscal burden of atrial fibrillation on the healthcare system and economic value of atrial fibrillation ablations brought to the patient and the payers by improvement in outcomes and reduction in treatment costs. Recent findings: This article summarizes the recently published studies evaluating the economic impact of atrial fibrillation treatment. Catheter ablation have shown to be the most successful strategy for treatment of defibrillation. However, repeat ablation is associated with higher costs, over and above any subsequent procedural costs, compared with a single ablation procedure for atrial fibrillation. Cryoballoon ablation has been shown to have fewer repeat ablations than radiofrequency ablations, which resulted in overall cost reduction. Improvement in laboratory efficiency, better utilization of laboratory resources and same-day discharge strategy can lead to further healthcare savings and increase in value to all stakeholders. Summary: The value of healthcare delivery for patient with atrial fibrillation can be improved by advancement in technology that demonstrates cost reduction to the health system and outcomes improvements. Implementation of tactics that decrease cost and improve outcomes can alleviate some of the financial strain on healthcare systems, which is of extreme importance in the current climate.

Background: Dual-chamber leadless pacing with the Aveir DR system restores atrioventricular synchrony without transvenous leads. The labeled implant workflow calls for a separate delivery catheter for each device. The second catheter adds cost and adds steps to the procedure, and whether it is actually needed has not been examined in a large series. Objective: To describe the acute procedural feasibility, the rate of delivery-catheter malfunction, and the effect on direct disposable supply cost of implanting both devices of a dual-chamber leadless pacemaker system through one delivery catheter. Methods: We reviewed 102 consecutive patients who received a dual-chamber leadless pacemaker at a single center between February 2024 and February 2025, implanted by five operators at that center. Twenty earlier dual-chamber implants performed with two catheters, before the single-catheter workflow was adopted, precede the study period and are not part of this cohort. The right ventricular device was placed first in every case. The same catheter was then reloaded with the atrial device and used for the second implant, and a new catheter was opened only if the first one failed. We recorded acute implant success, catheter malfunction, procedure time, fluoroscopy time, complications through 30 days after implantation, and direct disposable supply cost. Results: Both devices were implanted through the original catheter in 100 of 102 patients (98.0%, 95% CI 93.1 to 99.8%). Two patients (2.0%, 95% CI 0.2 to 6.9%) needed a catheter exchange because of a mechanical failure that arose during ventricular deployment; in both, the ventricular device had been recaptured and redeployed with repeated torque beforehand. No catheter failed during atrial implantation. Mean time from sheath insertion to removal was 69 min, and mean fluoroscopy time was 16.0 ± 6.6 min. Two device dislodgements occurred (2.0%, 95% CI 0.2 to 6.9%), one intraprocedural and one a right atrial device that embolized the day after implant; neither was related to the delivery catheter. There was no perforation, pericardial effusion, or access-site complication, and no other complication occurred in any patient through 30 days after implant. Omitting the second catheter lowered direct disposable supply cost by USD 1505 per case, 6.1% of the USD 24,510 two-catheter supply total. Conclusions: With experienced operators, one delivery catheter completed both implants in 98% of cases and lowered disposable supply cost. The study is single arm aand the number of events is small, so these findings support feasibility, with 30-day freedom from complications of 98.0%, and a supply cost difference.