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Catheter Ablation of Cardiac Arrhythmias
MA11.060g

Policy

SUPRAVENTRICULAR ARRHYTHMIAS

Catheter ablation of cardiac arrhythmias is considered medically necessary and, therefore, covered for individuals who have any of the following symptomatic supraventricular arrhythmias:
  • Supraventricular tachycardia
  • Accessory bypass tract arrhythmia (Wolff-Parkinson-White syndrome)
  • Atrial tachyarrhythmia (when ablation is intended to modify the atrioventricular junction to obtain ventricular rate control)
  • Sustained atrioventricular nodal re-entrant tachycardia
  • Atrial tachycardia or atrial flutter
Catheter ablation is considered medically necessary and, therefore, covered for any of the following:
  • Individuals with recurrent symptomatic paroxysmal atrial fibrillation (greater than one episode, with four or less episodes in the previous six months) in whom a rhythm-control strategy is desired, as an initial treatment
  • Individuals with symptomatic or persistent atrial fibrillation, who have failed at least one antiarrhythmic medication, as an alternative to continued medical management
  • Individuals with class II or III congestive heart failure and symptomatic atrial fibrillation in whom heart rate is poorly controlled by standard medications, as an alternative to atrial ventricular nodal ablation and pacemaker insertion
Repeat catheter ablation may be considered medically necessary in individuals with recurrence of atrial fibrillation and/or development of atrial flutter following the initial procedure.

VENTRICULAR ARRHYTHMIAS

Catheter ablation is considered medically necessary and, therefore, covered for individuals with ventricular arrhythmias who meet any the following conditions:
  • Bundle branch re-entrant ventricular tachycardia​
  • Interfascicular re-entrant ventricular tachycardia
  • Sustained monomorphic ventricular tachycardia
  • Ventricular dysfunction presumed to be caused by frequent premature ventricular contractions (PVC) (e.g., PVC induced cardiomyopathy)
  • Outflow tract PVC/ventricular tachycardia
  • Papillary muscle ventricular tachycardia
  • PVC induced polymorphic ventricular tachycardia/ventricular fibrillation
AND either of the following conditions:
  • Structural heart disease (i.e., ischemic or idiopathic cardiomyopathy)
  • Symptomatic ventricular tachycardia without structural heart disease
In addition, at least one of the following criteria must also be met:
  • Pharmacologic management of the arrhythmia is not tolerated or not desired by the individual.
  • The arrhythmia is drug-resistant (continued arrhythmia that has failed at least one trial of an antiarrhythmic drug at a therapeutic dose).
  • Pharmacologic management of the arrhythmia is contraindicated in the individual.
  • The procedure is being used as first-line therapy for individuals who have symptomatic idiopathic ventricular tachycardia/premature ventricular contractions (PVCs) from the right ventricular outflow tract (RVOT) or the left fascicles ventricular outflow tract (LVOT). 
Catheter ablation of cardiac arrhythmias is considered medically necessary and, therefore, covered for individuals who have chronic, recurrent monomorphic ventricular tachycardia that is refractory to antiarrhythmic therapy with an implantable cardioverter-defibrillator and antiarrhythmic medication, and for which an identifiable arrhythmogenic focus can be identified.

Catheter ablation of cardiac arrhythmias is considered medically necessary and, therefore, covered for individuals who have polymorphic ventricular tachycardia electrical "storm" also known as incessant ventricular tachycardia (i.e., at least three episodes of sustained ventricular tachycardia in a 24-hour period) that is not controlled with an antiarrhythmic drug at a therapeutic dose.

All other uses for catheter ablation of cardiac arrhythmias are considered not medically necessary and, therefore, not covered because the available published peer-reviewed literature does not support their use in the treatment of illness or injury.

REQUIRED DOCUMENTATION

The individual's medical record must reflect the medical necessity for the care provided. These medical records may include, but are not limited to: records from the professional provider's office, hospital, nursing home, home health agencies, therapies, and test reports.

The Company may conduct reviews and audits of services to our members, regardless of the participation status of the provider. All documentation is to be available to the Company upon request. Failure to produce the requested information may result in a denial for the service.​

Guidelines

There is no Medicare coverage determination addressing this service; therefore, the Company policy is applicable.

ATRIAL FIBRILLATION SUB-TYPES

  • Paroxysmal (episodes that last less than 7 days and are self-terminating)
  • Persistent (episodes that last for greater than 7 days and can be terminated pharmacologically or by electrical cardioversion)
  • Permanent
NEW YORK HEART ASSOCIATION CLASSIFICATION OF HEART FAILURE

Class​Patient Symptoms
Class I (Mild)No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, or dyspnea (shortness of breath).
Class II (Mild)Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results in fatigue, palpitation, or dyspnea.
Class III (Moderate)Marked limitation of physical activity. Comfortable at rest, but less than ordinary activity causes fatigue, palpitation, or dyspnea.
Class IV (Severe)Unable to carry out any physical activity without discomfort. Symptoms of cardiac insufficiency at rest. If any physical activity is undertaken, discomfort is increased.

BENEFIT APPLICATION

Subject to the terms and conditions of the applicable Evidence of Coverage, catheter ablation of cardiac arrhythmias and transcatheter radiofrequency ablation of the pulmonary veins is covered under the medical benefits of the Company’s Medicare Advantage products when the medical necessity criteria listed in this medical policy are met.

US FOOD AND DRUG ADMINISTRATION (FDA) STATUS

There are numerous devices approved by the FDA for catheter ablation of cardiac arrhythmias.​

Description

Catheter ablation of cardiac arrhythmias is a nonsurgical procedure that is used to correct an abnormality in the heart's electrical conduction system. Alterations or defects in the conduction system can lead to an abnormal rhythm (arrhythmia) that causes the heart to beat too fast or too slow, or to pump in an ineffective rhythmic pattern. Abnormal pumping of the heart causes the body's vital organs to receive less than optimal blood flow, which often has serious consequences.

Catheter ablation of cardiac arrhythmias is performed in an electrophysiology or cardiac catheterization laboratory. During the procedure, a catheter is threaded through a blood vessel and directed into the heart. Electrophysiology studies are performed to determine the location of the arrhythmia. Once the location is identified, the catheter is moved into position, and the tissue at the site is ablated (destroyed) by either radiofrequency energy (radiofrequency ablation) or intense cold (cryoablation). In some cases, multiple catheters may be used. This procedure is performed on individuals who prove resistant or intolerant to pharmacologic care or other means of treatment. The effect of ablation is usually permanent.

Atrial fibrillation is a common cardiac arrhythmia that may be triggered by discrete foci located within the pulmonary veins. Unlike other supraventricular arrhythmias, the situation is more complex for atrial fibrillation because there is not a single arrhythmogenic focus. In the late 1990s, it was recognized that atrial fibrillation most frequently arose from an abnormal focus at or near the junction of the pulmonary veins and the left atrium, thus leading to the feasibility of more focused, percutaneous ablation techniques.

Catheter ablation of the pulmonary veins, also known as pulmonary vein isolation, targets the trigger of atrial fibrillation within the pulmonary veins and electrically isolates the foci to eliminate the atrial fibrillation. Several approaches have emerged for pulmonary vein isolation, including segmental ostial ablation guided by pulmonary vein potential (electrical approach) and circumferential pulmonary vein ablation (anatomical approach). Pulmonary vein isolation is typically performed in an electrophysiology laboratory, using either radiofrequency or cryoablation technology.

Repeat pulmonary vein isolations following initial pulmonary vein isolation are commonly performed if atrial fibrillation recurs or if atrial flutter develops post-procedure. The need for repeat procedures may, in part, depend on clinical characteristics of the individual (e.g., age, persistent vs. paroxysmal atrial fibrillation, atrial dilatation) and the type of initial ablation performed. Repeat procedures are generally more limited than the initial procedure. For example, in cases where electrical reconnections occur as a result of incomplete ablation lines, a "touch up" procedure is done to correct gaps in the original ablation. In other cases where atrial flutter develops following ablation, a "flutter ablation" is performed, which is more limited than the original atrial fibrillation ablation procedure. In most of the published studies, success rates were based on having as many as three separate procedures, although these repeat procedures may be more limited than the initial procedure.​

References

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Bunch TJ, Weiss JP, Crandall BG, et al. Patients treated with catheter ablation for ventricular tachycardia after an ICD shock have lower long-term rates of death and heart failure hospitalization than do patients treated with medical management only. Heart Rhythm.2014;11(4):533-40.


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Deisenhofer I, Zrenner B, Yin YH, et al. Cryoablation versus radiofrequency energy for the ablation of atrioventricular nodal reentrant tachycardia (the CYRANO Study): results from a large multicenter prospective randomized trial. Circulation. 2010;122(22):2239-2245.

Deneke T, Shin DI, Lawo T, et al. Catheter ablation of electrical storm in a collaborative hospital network. Am J Cardiol. 2011;108(2):233-239.

Di Biase L, Mohanty P, Mohanty S, et al. 408-08 - Ablation vs. Amiodarone for Treatment of Persistent Atrial Fibrillation in Patients With Congestive Heart Failure and an Implanted device: Results from the AATAC Multicenter Randomized Trial. American College of Cardiology Scientific Sessions; 2016;133(17):1637-1644.

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Ghanbari H, Baser K, Yokokawa M, et al. Noninducibility in postinfarction ventricular tachycardia as an end point for ventricular tachycardia ablation and its effects on outcomes: a meta-analysis. Circ Arrhythm Electrophysiol. 2014;7(4):677-683.

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Gupta A, Perera T, Ganesan A, et al. Complications of catheter ablation of atrial fibrillation: a systematic review. Circ Arrhythm Electrophysiol. 2013;6(6):1082-1088.

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Hunter RJ, Berriman TJ, Diab I, et al. A randomized controlled trial of catheter ablation versus medical treatment of atrial fibrillation in heart failure (the CAMTAF trial). Circ Arrhythm Electrophysiol. 2014;7(1):31-38.

 

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Jais P, Cauchemez B, Macle L, et al. Catheter ablation versus antiarrhythmic drugs for atrial fibrillation: the A4 study. Circulation. 2008;118(24):2498-505.

 

Jones DG, Haldar SK, Hussain W, et al. A randomized trial to assess catheter ablation versus rate control in the management of persistent atrial fibrillation in heart failure. J Am Coll Cardiol. 2013;61(18):1894-903.

 

Kang KT, Etheridge SP, Kantoch MJ, et al. Current management of focal atrial tachycardia in children: a multicenter experience. Circ Arrhythm Electrophysiol. 2014;7(4):664-670.

 

Kang KT, Potts JE, Radbill AE, et al. Permanent junctional reciprocating tachycardia in children: a multicenter experience. Heart Rhythm. 2014;11(8):1426-1432. ​


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Kuck KH, Merkely B, Zahn R, et al. Catheter Ablation Versus Best Medical Therapy in Patients With Persistent Atrial Fibrillation and Congestive Heart Failure: The Randomized AMICA Trial. Circ Arrhythm Electrophysiol. 2019; 12(12): e007731.

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Kuck KH, Tilz RR, Deneke T, et al. Impact of substrate modification by catheter ablation on implantable cardioverter-defibrillator interventions in patients with unstable ventricular arrhythmias and coronary artery disease: results from the multicenter randomized controlled SMS (Substrate Modification Study). Circ Arrhythm Electrophysiol. 2017;10(3):e004422.

Kumar S, Fujii A, Kapur S, et al. Beyond the storm: comparison of clinical factors, arrhythmogenic substrate, and catheter ablation outcomes in structural heart disease patients with versus those without a history of ventricular tachycardia storm. J Cardiovasc Electrophysiol. 2017;28(1):56-67.

Kumar S, Romero J, Mehta NK, et al. Long-term outcomes after catheter ablation of ventricular tachycardia in patients with and without structural heart disease. Heart Rhythm. 2016;13(10):1957-1963.

Lakhani M, Saiful F, Parikh V, et al. Recordings of diaphragmatic electromyograms during cryoballoon ablation for atrial fibrillation accurately predict phrenic nerve injury. Heart Rhythm. 2014;11(3):369-374.

Lee MA, Weachter R, Pollak S, et al. The effect of atrial pacing therapies on atrial tachyarrhythmia burden and frequency: results of a randomized trial in patients with bradycardia and atrial tachyarrhythmias. J Am Coll Cardiol. 2003;41(11):1926-1932.

Lellouche N, Jais P, Nault I, et al. Early recurrences after atrial fibrillation ablation: prognostic value and effect of early reablation. J Cardiovasc Electrophysiol. 2008;19(6):599-605.


Levy S​. Overview of catheter ablation of cardiac arrhythmias. [UpToDate Web site]. 02/14/2022. Available at: https://www.uptodate.com/contents/overview-of-catheter-ablation-of-cardiac-arrhythmias?search=cardiac ablation&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1 [via subscription only]. Accessed June 29, 2023. ​

Linhart M, Bellman B, Mittman-Braun E, at al. Comparison of cryoablation and radiofrequency ablation of pulmonary veins in 40 patients with paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol. 2009;20:1343-1348.

Linhart M, Nielson A, Andrie RP, et al. Fluoroscopy of spontaneous breathing is more sensitive than phrenic nerve stimulation for detection of right phrenic nerve injury during cryoballoon ablation of atrial fibrillation. J Cardiovasc Electrophysiol. 2014;25(8):859-865.

Liu XH, Chen CF, Gao XF, et al. Safety and efficacy of different catheter ablations for atrial fibrillation: a systematic review and meta-analysis. Pacing Clin Electrophysiol. 2016;39(8):883-899.

Luik A, Merkel M, Hoeren D, et al. Rationale and design of the FreezeAF: a randomized controlled noninferiority trial comparing isolation of the pulmonary veins with the cryoballoon catheter versus open irrigated radiofrequency ablation in patients with paroxysmal atrial fibrillation. Am Heart J. 2010;159(4):555-60.e1.

Mallidi J, Nadkarni GN, Berger RD, et al. Meta-analysis of catheter ablation as an adjunct to medical therapy for treatment of ventricular tachycardia in patients with structural heart disease. Heart Rhythm. 2011;8(4):503-510.

Malmborg H, Lonnerholm S, Blomstrom P, et al. Ablation of atrial fibrillation with cryoballoon or duty-cycled radiofrequency pulmonary vein ablation catheter: a randomized controlled study comparing the clinical outcome and safety; the AF-COR study. Europace. 2013; 15(11):1567-1573.


Mark DB, Anstrom KJ, Sheng S, et al. Effect of catheter ablation vs medical therapy on quality of life among patients with atrial fibrillation: the CABANA randomized clinical trial. JAMA. 2019;321(13):1275-1285.


Marrouche NF, Brachmann J, Andresen D, et al. Catheter Ablation for Atrial Fibrillation with Heart Failure. N Engl J Med. 2018;378(5):417-427.

Mont L, Bisbal F, Hernandez-Madrid A, et al. Catheter ablation vs. antiarrhythmic drug treatment of persistent atrial fibrillation: a multicentre, randomized, controlled trial (SARA study). Eur Heart J. 2014;35(8):501-507.

Morillo CA, Verma A, Connolly SJ, et al. Radiofrequency ablation vs antiarrhythmic drugs as firstline treatment of paroxysmal atrial fibrillation (RAAFT-2): a randomized trial. JAMA. 2014;311(7):692-700.

Mork TJ, Kristensen J, Gerdes JC, et al. Catheter ablation for ventricular tachycardia in ischaemic heart disease; Acute success and long-term outcome. Scand Cardiovasc J. 2014;48(1):27-34.

Mussigbrodt A, Dinov B, Bertagnoli L, et al. Precordial QRS amplitude ratio predicts long-term outcome after catheter ablation of electrical storm due to ventricular tachycardias in patients with arrhythmogenic right ventricular cardiomyopathy. J Electrocardiol. 2015;48(1):86-92.

Nagashima K, Choi EK, Tedrow UB, et al. Correlates and prognosis of early recurrence after catheter ablation for ventricular tachycardia due to structural heart disease. Circ Arrhythm Electrophysiol. 2014;7(5):883-888.

Nair GM, Nery PB, Diwakaramenon S, et al. A systematic review of randomized trials comparing radiofrequency ablation with antiarrhythmic medications in patients with atrialfibrillation. J Cardiovasc Electrophysiol. 2009;20(2):138-144.

Nayyar S, Ganesan AN, Brooks AG, et al. Venturing into ventricular arrhythmia storm: a systematic review and meta-analysis. Eur Heart J. 2013;34(8):560-571.

Neumann T, Vogt J, Schumacher B, et al. Circumferential pulmonary vein isolation with the cryoballoon technique results from a prospective 3-center study. J Am Coll Cardiol. 2008;52(4):273-278.

Neumann T, Wojcik M, Berkowitsch A, et al. Cryoballoon ablation of paroxysmal atrial fibrillation: 5-year outcome after single procedure and predictors of success. Europace. 2013; 15(8):1143-1149.

Nielsen JC, Johannessen A, Raatikainen P, et al. Long-term efficacy of catheter ablation as first-line therapy for paroxysmal atrial fibrillation: 5-year outcome in a randomised clinical trial. Heart. 2017;103(5):368-376.

Noheria A, Kumar A, Wylie JV Jr, Josephson ME. Catheter ablation vs. antiarrhythmic drug therapy for atrial fibrillation: a systematic review. Arch Intern Med. 2008;168(6):581-586.

Nyong J, Amit G, Adler AJ, et al. Efficacy and safety of ablation for people with non-paroxysmal atrial fibrillation. Cochrane Database Syst Rev. 2016;11:CD012088.


Oomen A, Dekker LRC, Meijer A. Catheter ablation of symptomatic idiopathic ventricular arrhythmias: A five-year single-centre experience. Neth Heart J. Apr 2018;26(4):210-216.

Oral H, Pappone C, Chugh A, et al. Circumferential pulmonary-vein ablation for chronic atrial fibrillation. N Engl J Med. 2006;354(9):934-941.

O'Riordan M. STOP-AF and CABANA: trials show effectiveness of ablation over drugs in AF. [theheart.org.] 03/15/2010. Available at http://www.medscape.com/viewarticle/718509. Accessed June 29, 2023. 

PACES/HRS expert consensus statement on the management of the asymptomatic young patient with a Wolff-Parkinson-White (WPW, ventricular preexcitation) electrocardiographic pattern: developed in partnership between the Pediatric and Congenital Electrophysiology Society (PACES) and the Heart Rhythm Society (HRS). Endorsed by the governing bodies of PACES, HRS, the American College of Cardiology Foundation (ACCF), the American Heart Association (AHA), the American Academy of Pediatrics (AAP), and the Canadian Heart Rhythm Society (CHRS). Heart Rhythm. 2012;9(6):1006-1024. Available at: https://www.hrsonline.org/clinical-resources/2012-management-asymptomatic-young-patient-wolff-parkinson-white. Accessed June 29, 2023. 

Packer DL, Kowal RC, Wheelan KR, et al. Cryoballoon ablation of pulmonary veins for paroxysmal atrial fibrillation: first results of the North American Arctic Front (STOP AF) pivotal trial. J Am Coll Cardiol. 2013;61(16):1713-1723.


Packer DL, Piccini JP, Monahan KH, et al. Ablation Versus Drug Therapy for Atrial Fibrillation in Heart Failure: Results From the CABANA Trial. Circulation. 2021; 143(14):1377-1390. 

Page RL, Joglar JA, Caldwell MA, et al. 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm.2016;13(4):e136-221.

Pappone C, Augello G, Sala S, et al. A randomized trial of circumferential pulmonary vein ablation versus antiarrhythmic drug therapy in paroxysmal atrial fibrillation: the APAF Study. J Am Coll Cardiol. 2006;48(11):2340-2347.

Passman R. Catheter ablation to prevent recurrent atrial fibrillation: Anticoaggulation. [UpToDate]. 05/27/2022. Available at:
https://www.uptodate.com/contents/catheter-ablation-to-prevent-recurrent-atrial-fibrillation-clinical-applications?search=cardiac ablation&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2 [via subscription only]. Accessed June 29, 2023. 

Paylos JM, Hoyt RH, Ferrero C, et al. Complete pulmonary vein isolation using balloon cryoablation in patients with paroxysmal atrial fibrillation. Rev Esp Cardiol. 2009;62(11):1326-1331.

Pokushalov E, Romanov A, De Melis M, et al. Progression of atrial fibrillation after a failed initial ablation procedure in patients with paroxysmal atrial fibrillation: a randomized comparison of drug therapy versus reablation. Circ Arrhythm Electrophysiol. 2013; 6(4):754-760.


Pytkowski M, Maciag A, Jankowska A, et al. Quality of life improvement after radiofrequency catheter ablation of outflow tract ventricular arrhythmias in patients with structurally normal heart. Acta Cardiol. 2012;67(2):153-159.


Raymond JM, Sacher F, Winslow R, et al. Catheter ablation for scar-related ventricular tachycardias. Curr Probl Cardiol. 2009;34(5):225-270.

Reddy VY, Dukkipati SR, Neuzil P, et al. Randomized, controlled trial of the safety and effectiveness of a contact force-sensing irrigated catheter for ablation of paroxysmal atrial fibrillation: results of the TactiCath Contact Force Ablation Catheter Study for Atrial Fibrillation (TOCCASTAR) Study. Circulation. 2015;132(10):907-915.

Reddy VY, Reynolds MR, Neuzil P, et al. Prophylactic catheter ablation for the prevention of defibrillator therapy. N Engl J Med. 2007;357(26):2657-2665.

Rodriguez-Entem FJ, Exposito V, Gonzalez-Enriquez S, et al. Cryoablation versus radiofrequency ablation for the treatment of atrioventricular nodal reentrant tachycardia: results of a prospective randomized study. J Interv Card Electrophysiol. 2013;36(1):41-45; discussion 45.

Rodriguez LM, Smeets JL, Timmermans C, et al. Predictors for successful ablation of right- and left-sided idiopathic ventricular tachycardia. Am J Cardiol. 1997;79(3):309-314.

Rubin E, Schwartz S. Worldwide experience with the Arctic Front cardiac CryoAblation System for treatment of atrial fibrillation (Abstract). Cryobiology. 2013;66(3):353.

Santangeli P, Muser D, Maeda S, et al. Comparative effectiveness of antiarrhythmic drugs and catheter ablation for the prevention of recurrent ventricular tachycardia in patients with implantable cardioverter-defibrillators: A systematic review and meta-analysis of randomized controlled trials. Heart Rhythm. 2016;13(7):1552-1559.


Santangeli P, Muser D, Zado ES, et al. Acute hemodynamic decompensation during catheter ablation of scar-related VT: incidence, predictors and impact on mortality. Circ Arrhythm Electrophysiol. 2015;8(1):68-75.

Sapp JL, Wells GA, Parkash R, et al. Ventricular tachycardia ablation versus escalation of antiarrhythmic drugs. N Engl J Med. 2016;375(2):111-121.

Sawhney N, Anousheh R, Chen WC, et al. Five-year outcomes after segmental pulmonary vein isolation for paroxysmal atrial fibrillation. Am J Cardiol. 2009;104(3):366-372.

Schmidt M, Dorwarth U, Andresen D, et al. Cryoballoon versus RF Ablation in Paroxysmal Atrial Fibrillation: Results from the German Ablation Registry. J Cardiovasc Electrophysiol. 2014;25(1):1-7.

Schmidt M, Dorwarth U, Andresen D, et al. German ablation registry: Cryoballoon vs radiofrequency ablation in paroxysmal atrial fibrillation-One-year outcome data. Heart Rhythm. 2016;13(4):836-844.

Scott PA, Silberbauer J, Murgatroyd FD. The impact of adjunctive complex fractionated atrial electrogram ablation and linear lesions on outcomes in persistent atrial fibrillation: a meta-analysis. Europace. 2016;18(3):359-367.

Shah RU, Freeman JV, Shilane D, et al. Procedural complications, rehospitalizations, and repeat procedures after catheter ablation for atrial fibrillation. J Am Coll Cardiol. 2012;59(2):143-149.

Shemin RJ, Cox JL, Gillinov AM, et al. Guidelines for reporting data and outcomes for the surgical treatment of atrial fibrillation. Ann Thorac Surg. 2007;83(3):1225-1230.


Shi LZ, Heng R, Liu SM, et al. Effect of catheter ablation versus antiarrhythmic drugs on atrial fibrillation: A meta-analysis of randomized controlled trials. Exp Ther Med. 2015;10(2):816-822. 


Squara F, Zhao A, Marijon E, et al. Comparison between radiofrequency with contact force-sensing and secondgeneration cryoballoon for paroxysmal atrial fibrillation catheter ablation: a multicentre European evaluation. Europace. 2015;17(5):718-724.

Stabile G, Bertaglia E, Senatore G, et al. Catheter ablation treatment in patients with drug-refractory atrial fibrillation: a prospective, multi-centre, randomized, controlled study (Catheter Ablation for the Cure of Atrial Fibrillation Study). Eur Heart J. 2006;27(2):216-221.


Stevenson WG, Wilber DJ, Natale A, et al. Irrigated radiofrequency catheter ablation guided by electroanatomic mapping for recurrent ventricular tachycardia after myocardial infarction. The Multicenter Thermocool Ventricular Tachycardia Ablation Trial. Circulation. 2008;118(25):2773-2782.

Su W, Orme GJ, Hoyt R, et al. Retrospective review of Arctic Front Advance Cryoballoon Ablation: a multicenter examination of second-generation cryoballoon (RADICOOL trial). J Interv Card Electrophysiol. 2018; 51(3): 199-204.

Takigawa M, Takahashi A, Kuwahara T, et al. Long-term follow-up after catheter ablation of paroxysmal atrial fibrillation: the incidence of recurrence and progression of atrial fibrillation. Circ Arrhythm Electrophysiol. 2014;7(2):267-273.

Tanner H, Hindricks G, Volkmer M, et al. Catheter ablation of recurrent scar-related ventricular tachycardia using electroanatomic mapping and irrigated ablation technology: results of the prospective multicenter Euro-VT study. J Cardiovasc Electrophysiol. 2010;21(1):47-53.

Teunissen C, Kassenberg W, van der Heijden JF, et al. Five-year efficacy of pulmonary vein antrum isolation as a primary ablation strategy for atrial fibrillation: a single-centre cohort study. Europace. 2016;18(9):1335-1342.

Theis C, Konrad T, Mollnau H, et al. Arrhythmia termination versus elimination of dormant pulmonary vein conduction as a procedural end point of catheter ablation for paroxysmal atrial fibrillation: a prospective randomized trial. Circ Arrhythm Electrophysiol. 2015;8(5):1080-1087.


Tilz RR, Lin T, Eckardt L, et al. Ablation outcomes and predictors of mortality following catheter ablation for ventricular tachycardia: data from the German Multicenter Ablation Registry. J Am Heart Assoc. 2018;7(6):e007045.

Tzou WS, Marchlinski FE, Zado ES, et al. Long-term outcome after successful catheter ablation of atrial fibrillation. Circ Arrhythm Electrophysiol. 2010;3(3):237-242.

US Food and Drug Administration (FDA). Center for Devices and Radiological Health. Arctic Front CryoCatheter System. Premarket approval (PMA) database. [FDA Web site]. 12/17/2010. Available at: http://www.accessdata.fda.gov/cdrh_docs/pdf10/P100010a.pdf. Accessed June 29, 2023. 

US Food and Drug Administration (FDA). Center for Devices and Radiological Health (CDRH). CDRH Consumer Information. New device approval: 7F Freezor® Cardiac Cryoablation Catheter and CCT.2 CryoConsole System - P020045. [FDA Web site]. 04/17/03. (Updated: 03/11/2016). Available at: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpma/pma.cfm?id=P020045S074. Accessed June 29, 2023. 

US Food and Drug Administration (FDA). Center for Devices and Radiological Health (CDRH). Premarket approval (PMA) database. Helios II Ablation Catheter - P050029. [FDA Web site]. 10/10/08. Available at: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpma/pma.cfm?id=P050029. Accessed June 29, 2023. 

US Food and Drug Administration (FDA). Center for Devices and Radiological Health. Qwikstar DS Diagnostic/Ablation Catheter. Premarket approval (PMA) database. [FDA Web site]. 01/14/2004. Available at: http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpma/pma_template.cfm?id=p010068s002. Accessed June 29, 2023. 

Van Gelder IC, Hagens VE, Bosker HA, et al. A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation. N Engl J Med. 2002;347(23):1834-1840.

Verma A, Jiang CY, Betts TR, et al. Approaches to catheter ablation for persistent atrial fibrillation. N Engl J Med.2015;372(19):1812-1822.

Vogt J, Heintze J, Gutleben KJ, et al. Long-term outcomes after cryoballoon pulmonary vein isolation: results from a prospective study in 605 patients. J Am Coll Cardiol. 2013;61(16):1707-1712.

Waldo AL, Wilber DJ, Marchlinski FE, et al. Safety of the open-irrigated ablation catheter for radiofrequency ablation: safety analysis from six clinical studies. Pacing and clinical electrophysiology. PACE. 2012;35(9):1081-1089.

Wasserlauf J, Pelchovitz DJ, Rhyner J, et al. Cryoballoon versus radiofrequency catheter ablation for paroxysmal atrial fibrillation. Pacing Clin Electrophysiol. 2015;38(4):483-489.


Wazni OM, Dandamudi G, Sood N, et al. Cryoballoon Ablation as Initial Therapy for Atrial Fibrillation. N Engl J Med. 2021;384(4):316-324. 

Wazni OM, Marrouche NF, Martin DO, et al. Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment for symptomatic atrial fibrillation: a randomized trial. JAMA. 2005;293(21):2634-2640.

Weerasooriya R, Khairy P, Litalien J, et al. Catheter ablation for atrial fibrillation: are results maintained at 5 years of follow-up? J Am Coll Cardiol. 2011;57(2):160-166.

Wen MS, Yeh SJ, Wang CC, et al. Radiofrequency ablation therapy in idiopathic left ventricular tachycardia with no obvious structural heart disease. Circulation. 1994; 89(4):1690-1696.

Wilber DJ, Pappone C, Neuzil P, et al. Comparison of antiarrhythmic drug therapy and radiofrequency catheter ablation in patients with paroxysmal atrial fibrillation: a randomized controlled trial. JAMA. 2010;303(4):333-340.

Wyse DG, Waldo AL, DiMarco JP, et al. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med. 2002;347(23):1825-1833.

Xu J, Huang Y, Cai H, et al. Is cryoballoon ablation preferable to radiofrequency ablation for treatment of atrial fibrillation by pulmonary vein isolation. A meta-analysis. PLoS One. 2014;9(2):e90323.

Yu R, Ma S, Tung R, et al. Catheter ablation of scar-based ventricular tachycardia: Relationship of procedure duration to outcomes and hospital mortality. Heart Rhythm. 2015;12(1):86-94.

Zhu M, Zhou X, Cai H, et al. Catheter ablation versus medical rate control for persistent atrial fibrillation in patients with heart failure: A PRISMA-compliant systematic review and meta-analysis of randomized controlled
trials. Medicine (Baltimore). 2016;95(30):e4377.

Zhuang Y, Yong YH, Chen ML. Updating the evidence for the effect of radiofrequency catheter ablation on left atrial volume and function in patients with atrial fibrillation: a meta-analysis. JRSM Open. 2014;5(3):2054270414521185.


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​

Zipes DP, Calkins H, Daubert JP, et al. 2015 ACC/AHA/HRS Advanced Training Statement on Clinical Cardiac Electrophysiology (A Revision of the ACC/AHA 2006 Update of the Clinical Competence Statement on Invasive Electrophysiology Studies, Catheter Ablation, and Cardioversion). Circ Arrhythm Electrophysiol. 2015;8(6):1522-5.​​

Coding

CPT Procedure Code Number(s)
93650, 93653, 93654, 93655, 93656, 93657
ICD - 10 Procedure Code Number(s)
N/A
ICD - 10 Diagnosis Code Number(s)
THE FOLLOWING DIAGNOSIS CODES ARE APPROPRIATE TO REPORT WITH CPT CODE 93650:
I45.89 Other specified conduction disorders
I47.10 Supraventricular tachycardia, unspecified
I47.11 Inappropriate sinus tachycardia, so stated
I47.19 Other supraventricular tachycardia
I48.0 Paroxysmal atrial fibrillation
I48.11 Longstanding persistent atrial fibrillation
I48.19 Other persistent atrial fibrillation
I48.20 Chronic atrial fibrillation, unspecified
I48.21 Permanent atrial fibrillation
I48.3 Typical atrial flutter
I48.4 Atypical atrial flutter
I48.91 Unspecified atrial fibrillation
I48.92 Unspecified atrial flutter
I49.2 Junctional premature depolarization
I49.5 Sick sinus syndrome
I49.8 Other specified cardiac arrhythmias

THE FOLLOWING DIAGNOSIS CODES ARE APPROPRIATE TO REPORT WITH CPT CODE 93653:
I45.6 Pre-excitation syndrome
I45.89 Other specified conduction disorders
I47.10 Supraventricular tachycardia, unspecified
I47.11 Inappropriate sinus tachycardia, so stated
I47.19 Other supraventricular tachycardia
I48.0 Paroxysmal atrial fibrillation
I48.11 Longstanding persistent atrial fibrillation
I48.19 Other persistent atrial fibrillation
I48.20 Chronic atrial fibrillation, unspecified
I48.21 Permanent atrial fibrillation
I48.3 Typical atrial flutter
I48.4 Atypical atrial flutter
I48.91 Unspecified atrial fibrillation
I48.92 Unspecified atrial flutter
I49.5 Sick sinus syndrome
I49.8 Other specified cardiac arrhythmias

THE FOLLOWING DIAGNOSIS CODES ARE APPROPRIATE TO REPORT WITH CPT CODE 93654:
I47.0 Re-entry ventricular arrhythmia
I47.20 Ventricular tachycardia, unspecified
I47.21 Torsades de pointes
I47.29 Other ventricular tachycardia
I49.3 Ventricular premature depolarization

THE FOLLOWING DIAGNOSIS CODES ARE APPROPRIATE TO REPORT WITH CPT CODE 93655:
I45.6  Pre-excitation syndrome
I45.89  Other specified conduction disorders
I47.0 Re-entry ventricular arrhythmia
I47.10 Supraventricular tachycardia, unspecified
I47.11 Inappropriate sinus tachycardia, so stated
I47.19 Other supraventricular tachycardia
I47.20 Ventricular tachycardia, unspecified
I47.21 Torsades de pointes
I47.29 Other ventricular tachycardia
I48.0 Paroxysmal atrial fibrillation
I48.11 Longstanding persistent atrial fibrillation
I48.19 Other persistent atrial fibrillation
I48.20 Chronic atrial fibrillation, unspecified
I48.21 Permanent atrial fibrillation
I48.3 Typical atrial flutter
I48.4 Atypical atrial flutter
I48.91 Unspecified atrial fibrillation
I48.92 Unspecified atrial flutter
I49.3 Ventricular premature depolarization
I49.5 Sick sinus syndrome
I49.8 Other specified cardiac arrhythmias

THE FOLLOWING DIAGNOSIS CODES ARE APPROPRIATE TO REPORT WITH CPT CODE 93656:
I48.0 Paroxysmal atrial fibrillation
I48.11 Longstanding persistent atrial fibrillation
I48.19 Other persistent atrial fibrillation
I48.20 Chronic atrial fibrillation, unspecified
I48.21 Permanent atrial fibrillation
I48.3 Typical atrial flutter
I48.4 Atypical atrial flutter
I48.91 Unspecified atrial fibrillation
I48.92 Unspecified atrial flutter

THE FOLLOWING DIAGNOSIS CODES ARE APPROPRIATE TO REPORT WITH CPT CODE 93657:
I48.0 Paroxysmal atrial fibrillation
I48.11 Longstanding persistent atrial fibrillation
I48.19 Other persistent atrial fibrillation
I48.20 Chronic atrial fibrillation, unspecified
I48.21 Permanent atrial fibrillation
I48.3 Typical atrial flutter
I48.4 Atypical atrial flutter
I48.91 Unspecified atrial fibrillation
I48.92 Unspecified atrial flutter​
HCPCS Level II Code Number(s)
C1732 Catheter, electrophysiology, diagnostic/ablation, 3D or vector mapping

C1733 Catheter, electrophysiology, diagnostic/ablation, other than 3D or vector mapping, other than cool-tip

C2630 Catheter, electrophysiology, diagnostic/ablation, other than 3D or vector mapping, cool-tip
Revenue Code Number(s)
N/A


Coding and Billing Requirements

Policy History

​Revisions From MA11.060g:
10/01/2023

Inclusion of a policy in a Code Update memo does not imply that a full review of

the policy was completed at this time.

 

This policy has been identified for the ICD-10 code update, effective 10/01/2023.


The following ICD-10 code has been termed and removed from this policy:

I47.1 Supraventricular tachycardia


The following ICD-10 codes have been added to this policy:

I47.10   Supraventricular tachycardia, unspecified

I47.11  Inappropriate sinus tachycardia, so stated

I47.19 Other supraventricular tachycardia​


Revisions From MA11.060f:
09/25/2023

This version of the policy will become effective 09/25/2023.


This policy was updated to revise medical necessity criteria for ventricular arrhythmias. ​


Revisions From MA11.060e:
10/01/2022

Inclusion of a policy in a Code Update memo does not imply that a full review of

the policy was completed at this time.

 

This policy has been identified for the ICD-10 code update, effective 10/01/2022.


The following ICD-10 code has been termed and removed from this policy:

I47.2 Ventricular tachycardia


The following ICD-10 codes have been added to this policy:

I47.20   Ventricular tachycardia, unspecified

I47.21   Torsades de pointes

I47.29   Other ventricular tachycardia​


Revisions From MA11.060d:
​​06/29/2022
​This policy has been reissued in accordance with the Company's annual review process.
01/01/2022

Inclusion of a policy in a Code Update memo does not imply that a full review of

the policy was completed at this time.

 

This policy has been identified for the CPT code update, effective 01/01/2022.


The following CPT narratives have been revised in this policy:​ 93653, 93654 and 93656.


Revisions From MA11.060c:
09/08/2021

The policy has been reviewed and reissued to communicate the Company’s continuing position on Catheter Ablation of Cardiac Arrhythmias.​​
​11/18/2020

​The policy has been reviewed and reissued to communicate the Company’s continuing position on Catheter Ablation of Cardiac Arrhythmias.​​
​10/01/2019
​This policy has been identified for the ICD-10 code update, effective 10/01/2019.

The following ICD-10 codes has been added to this policy:

I48.11 Longstanding persistent atrial fibrillation

I48.19 Other persistent atrial fibrillation

I48.20 Chronic atrial fibrillation, unspecified

I48.21 Permanent atrial fibrillation

The following ICD-10 codes has been deleted to this policy:

I48.1 Persistent atrial fibrillation

I48.2 Chronic atrial fibrillation​


Revisions From MA11.060b:
02/23/2018This policy has undergone a routine review, and the medical necessity criteria have been revised as follows:
  • Symptomatic paroxysmal atrial fibrillation clarified as recurrent or greater than one episode, with four or less episodes in the previous six months.
  • Polymorphic ventricular tachycardia electrical "storm" also known as incessant ventricular tachycardia defined as at least three episodes of sustained ventricular tachycardia in a 24-hour period.

Revisions From MA11.060a:
06/07/2017This policy has been reissued in accordance with the Company's annual review process.
05/18/2016This version of the policy will become effective 05/18/2016.

The policy was reformatted to add sections for Supraventricular and Ventricular treatment criteria, and text under Pulmonary Vein Isolation was relocated to Supraventricular section.

The criteria for ablation treatment of atrial fibrillation was changed
FROM: refractory to at least one trial of an antiarrhythmic drug at a therapeutic dose
TO: may be considered as an initial treatment for individuals with symptomatic paroxysmal atrial fibrillation in whom a rhythm-control strategy is desired.

The following HCPCS Codes have been added to this policy:
C1732 Catheter, electrophysiology, diagnostic/ablation, 3D or vector mapping
C1733 Catheter, electrophysiology, diagnostic/ablation, other than 3D or vector mapping, other than cool-tip
C2630 Catheter, electrophysiology, diagnostic/ablation, other than 3D or vector mapping, cool-tip

Revisions From MA11.060:
04/15/2015The policy has been reviewed and reissued to communicate the Company’s continuing position on Catheter Ablation of Cardiac Arrhythmias.
01/01/2015This is a new policy.​
10/1/2023
9/29/2023
MA11.060
Medical Policy Bulletin
Medicare Advantage
No
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