Catheter and Surgical Ablation of Atrial Fibrillation
Diagnosis
Table 2a. Indications for Catheter Ablation of Atrial Fibrillation
Symptomatic AF refractory or intolerant to at least one Class 1 or 3 antiarrhythmic medication
Symptomatic AF prior to initiation of antiarrhythmic therapy with a Class 1 or 3 antiarrhythmic medication
Table 2b. Indications for Atrial Fibrillation Ablation in Populations of Patients Not Well Represented in Clinical Trials
Congestive heart failure
Older patients (>75 years of age)
Hypertrophic cardiomyopathy
Young patients (<45 years of age)
Tachy-brady syndrome
Athletes with AF
Asymptomatic AFa
Table 2c. Indications for Concomitant Open (such as Mitral Valve) Surgical Ablation of Atrial Fibrillation
Symptomatic AF refractory or intolerant to at least one Class 1 or 3 antiarrhythmic medication
Symptomatic AF prior to initiation of antiarrhythmic therapy with a Class 1 or 3 antiarrhythmic medication
Table 2d. Indications for Concomitant Closed (such as CABG and AVR) Surgical Ablation of Atrial Fibrillation
Symptomatic AF refractory or intolerant to at least one Class 1 or 3 antiarrhythmic medication
Symptomatic AF prior to initiation of antiarrhythmic therapy with a Class 1 or 3 antiarrhythmic medication
Table 2e. Indications for Stand-Alone and Hybrid Surgical Ablation of Atrial Fibrillation
Symptomatic AF refractory or intolerant to at least one Class 1 or 3 antiarrhythmic medication
Treatment
Table 3. Atrial Fibrillation Ablation: Strategies, Techniques, and Endpoints
PV isolation by catheter ablation
Ablation strategies to be considered for use in conjunction with PV isolation
Ablation strategies to be considered for use in conjunction with PV isolation
Nonablation strategies to improve outcomes
Strategies to reduce the risks of AF ablation
Table 4. Anticoagulation Strategies: Pre-, During, and Post-Catheter Ablation of AF
Preablation
During ablation
Postablation
Recommendation Grading
Overview
Title
Catheter and Surgical Ablation of Atrial Fibrillation
Authoring Organization
Heart Rhythm Society
Publication Month/Year
April 8, 2024
Last Updated Month/Year
May 1, 2024
Document Type
Consensus
External Publication Status
Published
Country of Publication
Global
Document Objectives
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society .
Inclusion Criteria
Male, Female, Adult, Older adult
Health Care Settings
Hospital, Operating and recovery room
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Diagnosis, Treatment
Diseases/Conditions (MeSH)
D001281 - Atrial Fibrillation, D020517 - Atrial Appendage, D001282 - Atrial Flutter, D013612 - Tachycardia, Ectopic Atrial
Keywords
atrial fibrillation, anticoagulation, catheter ablation, stroke, atrial tachycardia (AT), atrial flutter, ablation, arrhythmia, surgical ablation, Anticoagulation
Source Citation
Tzeis S, Gerstenfeld EP, Kalman J, Saad EB, Sepehri Shamloo A, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O'Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY, Steven D, Agbayani MJ, Jared Bunch T, Chugh A, Díaz JC, Freeman JV, Hardy CA, Heidbuchel H, Johar S, Linz D, Maesen B, Noseworthy PA, Oh S, Porta-Sanchez A, Potpara T, Rodriguez-Diez G, Sacher F, Suwalski P, Trines SA. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace. 2024 Mar 30;26(4):euae043. doi: 10.1093/europace/euae043. PMID: 38587017; PMCID: PMC11000153.