Later this week, a federal advisory committee will consider whether Medicare should pay for an expensive procedure to treat atrial fibrillation, a common heart ailment in seniors. The use of catheter ablation, where invasive cardiologists snake a thin tube into the chambers of the heart to remove tissue growths that trigger rhythm disorders, has doubled in the past few years, and already costs the government over $2 billion a year. That total will jump exponentially if Medicare issues a "national coverage decision" to expand its use to atrial fibrillation, which affects more than two million seniors.

The evidence recommending catheter ablation for atrial fibrillation (AF) is sparse. The evidence that it reduces mortality and strokes -- the most debilitating consequence of AF -- is non-existent.

What it can do is improve the lifestyles of some seniors for whom AF is a frequent and unwanted companion, one that during extreme episodes can lead to hospitalization. The hope that catheter ablation will achieve those benefits is driving more and more seniors with persistent AF to the cath lab, despite the fact it works only two-thirds of the time, often has to be repeated, and has severe, even life-threatening consequences in 1 to 3 percent of cases.

Not surprisingly, the expanded use is being stoked by leading companies in the medical device industry, which increasingly see catheter ablation as a major growth area, one that can make up for flagging sales of their flagship drug-eluting stent products.

It's worth taking a closer look at the issues behind the expanding use of catheter ablation for AF, since it is a textbook example of how the complex interplay of rapidly advancing new technologies, the mutual self-interest of narrow medical specialties and innovator firms, and the demographics of an aging society drive health care costs skyward -- all for minimal gains in overall public health.