Catheter and Surgical Ablation of Atrial Fibrillation
Key Points
Key Points
- Catheter and surgical ablation of atrial fibrillation (AF) are well established and important treatment options for patients with atrial fibrillation in whom a rhythm control strategy is chosen.
- A decision to perform catheter or surgical ablation of AF should be made after a careful consideration of the efficacy, risks, and alternatives to undergoing the ablation procedure. Patient preferences and values are important consideration. This document provides indications for both catheter and surgical AF ablation.
- The primary indication for performance of AF ablation is the presence of symptoms associated with atrial fibrillation. AF ablation is generally considered after at least one antiarrhythmic medication has been tried and proven to be ineffective or poorly tolerated.
- A desire to stop anticoagulation is not an appropriate indication for AF ablation. For most patients with AF who have a high stroke risk profile, anticoagulation should be continued following their ablation procedure.
- Catheter ablation of AF is associated with a risk of complications including development of a stroke or transient ischemic attack. Careful attention to anticoagulation prior to, during, and following the ablation procedure minimizes these risks.
- Multiple tools and strategies are available to perform both catheter and surgical ablation of AF. This document provides a detailed review of each of the available options and recommendations are made.
- There is considerable effort focused on developing new tools and techniques for AF ablation. This document contained recommendations concerning the performance of future clinical trials.
Table 1. Atrial Fibrillation Definitions
...Fibrillation DefinitionsHaving trouble v...
Diagnosis
...gnosis...
...able 2a. Indications for Catheter Ablation of...
...aroxysmal: Catheter ablation is recommended. (...
...ersistent: Catheter ablation is reasonable...
...standing persistent: Catheter ablation may be cons...
...Catheter ablation is reasonable. (IIa...
Persistent: Catheter ablation is reasonable...
...g-standing persistent: Catheter ablation may...
...Indications for Atrial Fibrillatio...
...ve heart failure...
...is reasonable to use similar indications for AF a...
...tients (>75 years of age)
...ble to use similar indications for AF ablation in...
...phic cardiomyopathy
...able to use similar indications fo...
...ng patients (...
...asonable to use similar indications for...
...chy-brady syndrome...
...sonable to offer AF ablation as an alt...
...etes with AF...
...easonable to offer high-level athletes AF ablation...
...smal: Catheter ablation may be considered in se...
...heter ablation may be considered in select pa...
...2c. Indications for Concomitant Open...
...ical ablation is recommended. (I, B-N...
...rsistent: Surgical ablation is recommended...
...standing persistent: Surgical ablati...
...aroxysmal: Surgical ablation is recommende...
...tent: Surgical ablation is recommended. (I,...
...ong-standing persistent: Surgical ablation i...
...cations for Concomitant Closed (such as CABG...
...ical ablation is recommended. (I, B-NR)573...
...: Surgical ablation is recommended. (I, B...
...anding persistent: Surgical ablation is recomme...
...smal: Surgical ablation is reasonable. (...
...sistent: Surgical ablation is reasonable....
...ding persistent: Surgical ablation is reaso...
...e. Indications for Stand-Alone and Hybrid Surgica...
...nd-alone surgical ablation can be considered...
...d-alone surgical ablation is reasonable for...
...rsistent: Stand-alone surgical ablation is r...
...ay be reasonable to apply the indications for sta...
Treatment
...reatment...
...trial Fibrillation Ablation: Strat...
...tion of the PVs is recommended during...
...ent of electrical isolation requires,...
...itoring for PV reconnection for 20...
...dministration of adenosine 20 minute...
...pture (pacing along the ablation li...
...emonstration of exit block may be con...
...the patient has a history of typical atrial f...
If linear ablation lesions are applie...
...cible focal trigger that initiates AF is id...
When performing AF ablation with a force-sensing...
...l isolation might be considered for initial o...
...ion of high-dose isoproterenol to screen...
...tion frequency (DF)-based ablation...
...sefulness of creating linear ablation...
...ss of linear ablation lesions in the abse...
...of mapping and ablation of areas of a...
...s of ablation of complex fractionated...
...of ablation of rotational activity as...
...ness of ablation of autonomic ganglia as an i...
...can be useful for patients with AF, including...
...ble to consider a patient’s body mass...
...t is reasonable to screen for signs...
...ment of sleep apnea can be useful f...
...he usefulness of discontinuation of an...
...ss of initiation or continuation of antiarrhythm...
...reful identification of the PV ost...
...is recommended that RF power be red...
...to use an esophageal temperature probe duri...
...nticoagulation Strategies: Pre-, During, an...
...undergoing AF catheter ablation who have be...
...ergoing AF catheter ablation who have be...
...undergoing AF catheter ablation who have been...
...nticoagulation guidelines that pertain to cardio...
...icoagulated with a NOAC prior to A...
...formance of a transesophageal echocardiogra...
...f a TEE in patients who present for ablation in s...
...cardiac echocardiography to screen f...
...hould be administered prior to or imm...
...f protamine following AF catheter abla...
...o are not therapeutically anticoagulated prio...
...ticoagulation with warfarin or a NOAC is reco...
...to AF anticoagulation guidelines is r...
...rding continuation of systemic anti...
...n patients who have not been anticoagulat...
...nts in whom discontinuation of anticoagulati...
...Signs and Symptoms Following AF AblationHavi...
...pes of Ambulatory Cardiac Monitorin...
...tions of Complications Associated with AF A...
...ence, Prevention, Diagnosis, and Treatment of Sele...
...ical Drawings of the Heart Relevant to AF Ablatio...
.... Posterior Perspective of the Left Atrium and Pu...
...Schematic Drawing Showing Various Hypothes...
.... Structure and Mechanisms of AF...
.... Mechanisms of Atrial Flutter and Atrial Tachy...
...e 6. Schematic of Common Lesion Set...
...7. Indications for Catheter Ablation of...
...ndications for Surgical Ablation of AF...
...9. Catheter Ablation of AF Using Either RF Energy...