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...
Diagnosis
Diagnos...
.... Indications for Catheter Ablation of Atrial Fib...
...oxysmal: Catheter ablation is recomm...
...ersistent: Catheter ablation is rea...
...ing persistent: Catheter ablation may be consid...
...Catheter ablation is reasonable. (IIa,...
...nt: Catheter ablation is reasonable. (IIa,...
...ersistent: Catheter ablation may be considered...
...Indications for Atrial Fibrillation Ablation i...
Congestive heart failur...
...e to use similar indications for AF ablatio...
...atients (>75 years of age)...
...easonable to use similar indications for AF abl...
...trophic cardiomyopathy...
...s reasonable to use similar indications...
...patients (...
...sonable to use similar indications for AF ablatio...
...brady syndrome...
It is reasonable to offer AF ablation as an alte...
...etes with AF...
...is reasonable to offer high-level athlet...
...: Catheter ablation may be consider...
...t: Catheter ablation may be considered in sele...
...able 2c. Indications for Concomitant...
Paroxysmal: Surgical ablation is recommen...
...rsistent: Surgical ablation is recommended....
...persistent: Surgical ablation is recommended...
...mal: Surgical ablation is recommended. (I, B-...
Persistent: Surgical ablation is re...
...anding persistent: Surgical ablatio...
...tions for Concomitant Closed (such as CA...
...roxysmal: Surgical ablation is recommended. (I, B-...
Persistent: Surgical ablation is re...
...ng persistent: Surgical ablation is reco...
...roxysmal: Surgical ablation is reasonab...
...ent: Surgical ablation is reasonable...
...ing persistent: Surgical ablation is reasonabl...
...Indications for Stand-Alone and Hybr...
...and-alone surgical ablation can be...
...sistent: Stand-alone surgical ablation is reason...
...anding persistent: Stand-alone surgical abl...
...may be reasonable to apply the indicatio...
Treatment
...atment...
...Atrial Fibrillation Ablation: Strategies, Techni...
...rical isolation of the PVs is recommen...
...of electrical isolation requires,...
Monitoring for PV reconnection for 20 min...
...on of adenosine 20 minutes following in...
...e-capture (pacing along the ablation line) ablati...
...ration of exit block may be considered. (IIb,...
...patient has a history of typical...
...ablation lesions are applied, operat...
...cible focal trigger that initiates AF i...
...ing AF ablation with a force-sensing RF ablat...
...wall isolation might be considered for initial or...
...ration of high-dose isoproterenol to...
...citation frequency (DF)-based abla...
...fulness of creating linear ablation lesions in...
...ulness of linear ablation lesions in th...
...ness of mapping and ablation of areas of abnor...
...ess of ablation of complex fractionated atria...
...efulness of ablation of rotational activity...
...usefulness of ablation of autonomi...
...t loss can be useful for patients with AF,...
...reasonable to consider a patientâ...
...ble to screen for signs and symptoms of sleep...
...sleep apnea can be useful for patien...
...lness of discontinuation of antiar...
...efulness of initiation or continuation of a...
...eful identification of the PV ostia is mandatory t...
...recommended that RF power be reduc...
...is reasonable to use an esophageal temperature pr...
.... Anticoagulation Strategies: Pre-,...
...ts undergoing AF catheter ablation who h...
...patients undergoing AF catheter ablation who hav...
...dergoing AF catheter ablation who have been ther...
...n guidelines that pertain to cardioversion of AF...
...anticoagulated with a NOAC prior to AF cathet...
...transesophageal echocardiogram (TE...
...ce of a TEE in patients who present for ablati...
...racardiac echocardiography to scre...
...ld be administered prior to or immediately follo...
...tion of protamine following AF cat...
...nts who are not therapeutically anticoag...
...temic anticoagulation with warfarin or a NOAC is...
...anticoagulation guidelines is recommend...
...sions regarding continuation of systemic a...
In patients who have not been anticoagulat...
...whom discontinuation of anticoagulat...
...nd Symptoms Following AF AblationHav...
Table 6. Types of Ambulatory Cardiac Monitoring...
...nitions of Complications Associated with AF Ab...
...nce, Prevention, Diagnosis, and Trea...
...ure 1. Anatomical Drawings of the Heart Relevant t...
Figure 2. Posterior Perspective of th...
...hematic Drawing Showing Various Hy...
...4. Structure and Mechanisms of AF...
...anisms of Atrial Flutter and Atrial Ta...
...6. Schematic of Common Lesion Sets Employed in A...
...ications for Catheter Ablation of Symp...
Figure 8. Indications for Surgical Ab...
...Catheter Ablation of AF Using Either RF Ener...