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
...le 1. Atrial Fibrillation DefinitionsHaving...
Diagnosis
Diagnosi...
...cations for Catheter Ablation of Atrial Fibrilla...
Paroxysmal: Catheter ablation is recomm...
...t: Catheter ablation is reasonable. (IIa...
...g persistent: Catheter ablation may be considered....
...al: Catheter ablation is reasonable. (IIa, B-R)57...
...Catheter ablation is reasonable. (I...
...ng-standing persistent: Catheter ablati...
...ications for Atrial Fibrillation Ablation in Pop...
...gestive heart failure...
...is reasonable to use similar indicati...
...nts (>75 years of age)...
...sonable to use similar indications for AF...
...pertrophic cardiomyopathy...
...reasonable to use similar indications for AF abl...
...oung patien...
...s reasonable to use similar indications...
...chy-brady syndrome...
...easonable to offer AF ablation as an alt...
...tes with AF...
...to offer high-level athletes AF abla...
...atheter ablation may be considered in se...
...sistent: Catheter ablation may be co...
...ndications for Concomitant Open (such as Mi...
...Surgical ablation is recommended. (I, B-NR)5...
...t: Surgical ablation is recommended. (I, B-NR)...
...ding persistent: Surgical ablation is recommended....
...mal: Surgical ablation is recommended. (I, B...
...rgical ablation is recommended. (I, B-NR)57...
...rsistent: Surgical ablation is recommende...
...Indications for Concomitant Closed (such as C...
...aroxysmal: Surgical ablation is recommend...
...istent: Surgical ablation is recommended....
...ing persistent: Surgical ablation is recomm...
...aroxysmal: Surgical ablation is reasona...
...gical ablation is reasonable. (IIa, B-NR)573...
...g persistent: Surgical ablation is...
...Indications for Stand-Alone and Hybrid Surgical A...
...Stand-alone surgical ablation can be considered...
...sistent: Stand-alone surgical ablation is re...
...g-standing persistent: Stand-alone surgical ab...
...able to apply the indications for stand-...
Treatment
...eatmen...
...Fibrillation Ablation: Strategies, Te...
...lation of the PVs is recommended during a...
...f electrical isolation requires, at a minim...
...onitoring for PV reconnection for 20 minutes fol...
...on of adenosine 20 minutes following...
...pace-capture (pacing along the ablation line...
Demonstration of exit block may be considered. (...
...the patient has a history of typical atrial flutt...
...inear ablation lesions are applied, o...
...oducible focal trigger that initiates AF...
...orming AF ablation with a force-sensing RF...
...osterior wall isolation might be cons...
...of high-dose isoproterenol to screen for...
...ant excitation frequency (DF)-based ablation str...
...of creating linear ablation lesion...
...usefulness of linear ablation lesions in the absen...
...lness of mapping and ablation of areas o...
...he usefulness of ablation of complex fracti...
...f ablation of rotational activity as...
...of ablation of autonomic ganglia as an initi...
...be useful for patients with AF, includin...
...able to consider a patient’s body mass index (...
...able to screen for signs and symptoms of...
...eep apnea can be useful for patien...
...of discontinuation of antiarrhythmic dru...
...e usefulness of initiation or continuation of anti...
Careful identification of the PV ostia is m...
...recommended that RF power be reduced w...
...nable to use an esophageal temperature probe dur...
.... Anticoagulation Strategies: Pre-, Du...
...or patients undergoing AF catheter ablation who h...
...r patients undergoing AF catheter ablation wh...
...nts undergoing AF catheter ablation who have...
...tion guidelines that pertain to cardi...
...atients anticoagulated with a NOAC prior to AF...
...a transesophageal echocardiogram (TEE) in...
...ance of a TEE in patients who present for ablation...
...se of intracardiac echocardiography to s...
...rin should be administered prior to or immedi...
...inistration of protamine following AF...
...ts who are not therapeutically anticoag...
...icoagulation with warfarin or a NOAC...
...anticoagulation guidelines is recommende...
Decisions regarding continuation of syste...
...patients who have not been anticoagulated prio...
...whom discontinuation of anticoagulation is bei...
...and Symptoms Following AF Ablatio...
...pes of Ambulatory Cardiac Monitoring Dev...
...7. Definitions of Complications Associ...
Table 8. Incidence, Prevention, Di...
...omical Drawings of the Heart Relev...
...gure 2. Posterior Perspective of the Left...
...hematic Drawing Showing Various Hyp...
...4. Structure and Mechanisms of AF...
...5. Mechanisms of Atrial Flutter and Atri...
...Schematic of Common Lesion Sets Em...
...tions for Catheter Ablation of Symptomat...
...Indications for Surgical Ablation of...
.... Catheter Ablation of AF Using Either RF Energy o...