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
Table 1. Atrial Fibrillation Definitio...
Diagnosis
...gnosis
...Indications for Catheter Ablation...
...smal: Catheter ablation is recommended....
...ent: Catheter ablation is reasonable. (IIa,...
...ing persistent: Catheter ablation may be co...
...Catheter ablation is reasonable. (IIa, B-R)...
...nt: Catheter ablation is reasonable. (IIa, C-EO...
...ersistent: Catheter ablation may be co...
...ications for Atrial Fibrillation Ablatio...
...ngestive heart f...
...s reasonable to use similar indication...
...r patients (>75 years of age)...
...le to use similar indications for AF abl...
...ophic cardiomyopath...
...sonable to use similar indications fo...
...ung patients (...
...reasonable to use similar indications for AF abla...
...achy-brady syndrome
...reasonable to offer AF ablation as an alternati...
...hletes with A...
...t is reasonable to offer high-leve...
...mal: Catheter ablation may be conside...
...istent: Catheter ablation may be considered in se...
...le 2c. Indications for Concomitant...
...ysmal: Surgical ablation is recommended. (I, B-...
...ent: Surgical ablation is recommended. (...
...g-standing persistent: Surgical ablation is rec...
...Surgical ablation is recommended. (I, B-NR)573...
...gical ablation is recommended. (I, B-NR)...
...-standing persistent: Surgical ablation is r...
...ations for Concomitant Closed (such as C...
...urgical ablation is recommended. (...
...sistent: Surgical ablation is recommen...
...ong-standing persistent: Surgical a...
...al: Surgical ablation is reasonable. (I...
...: Surgical ablation is reasonable. (IIa, B-NR...
...ding persistent: Surgical ablation is reasonabl...
...Indications for Stand-Alone and Hybrid Surgical...
...Stand-alone surgical ablation can be consid...
...t: Stand-alone surgical ablation is...
...ding persistent: Stand-alone surgical ablati...
...may be reasonable to apply the indications f...
Treatment
...atment
...ble 3. Atrial Fibrillation Ablation:...
...ectrical isolation of the PVs is recommended duri...
...ent of electrical isolation requires...
...ng for PV reconnection for 20 minutes fo...
...of adenosine 20 minutes following initial P...
...apture (pacing along the ablation...
...exit block may be considered. (IIb, B-NR)573...
...t has a history of typical atrial flutter or typic...
...near ablation lesions are applied, op...
...ble focal trigger that initiates AF is i...
...ing AF ablation with a force-sensing RF ablation c...
...isolation might be considered for i...
...of high-dose isoproterenol to screen...
...excitation frequency (DF)-based ablat...
...ss of creating linear ablation lesions in the rig...
...fulness of linear ablation lesions in the...
...fulness of mapping and ablation of are...
...f ablation of complex fractionated atrial...
...ulness of ablation of rotational activity as...
...of ablation of autonomic ganglia as...
...loss can be useful for patients with A...
...le to consider a patient’s body mass i...
It is reasonable to screen for signs and symptoms...
...atment of sleep apnea can be useful for patients...
The usefulness of discontinuation of ant...
...f initiation or continuation of antiarrhythmic...
...l identification of the PV ostia is mandatory to...
It is recommended that RF power be reduced when...
...is reasonable to use an esophageal temperature...
...oagulation Strategies: Pre-, Durin...
...ents undergoing AF catheter ablation wh...
...undergoing AF catheter ablation who have been th...
...nts undergoing AF catheter ablation who hav...
...coagulation guidelines that pertain to cardio...
...tients anticoagulated with a NOAC pri...
...transesophageal echocardiogram (TEE) in pat...
...TEE in patients who present for ablation...
...cardiac echocardiography to screen for atrial thro...
...be administered prior to or immediately fo...
...of protamine following AF catheter...
...n patients who are not therapeutically...
...stemic anticoagulation with warfarin or a NOAC...
...AF anticoagulation guidelines is recommended f...
...rding continuation of systemic anticoagulation mor...
...ents who have not been anticoagulated prior to...
...ts in whom discontinuation of antic...
...le 5. Signs and Symptoms Following AF AblationHavi...
.... Types of Ambulatory Cardiac Monitorin...
...initions of Complications Associated with AF Abl...
...Incidence, Prevention, Diagnosis, a...
.... Anatomical Drawings of the Heart Re...
...igure 2. Posterior Perspective of the Left Atri...
Figure 3. Schematic Drawing Showing Various Hyp...
...ructure and Mechanisms of AF...
.... Mechanisms of Atrial Flutter and Atrial Tachycar...
...6. Schematic of Common Lesion Sets Employed...
...igure 7. Indications for Catheter Ab...
...cations for Surgical Ablation of AF — Conco...
.... Catheter Ablation of AF Using Either...