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
...trial Fibrillation DefinitionsHaving trouble vie...
Diagnosis
...agnosis...
...cations for Catheter Ablation of Atrial Fibril...
...roxysmal: Catheter ablation is recomme...
...istent: Catheter ablation is reasonable. (IIa, B-N...
Long-standing persistent: Catheter ablation may b...
...theter ablation is reasonable. (IIa, B-R)573...
...sistent: Catheter ablation is reasonable. (IIa...
...rsistent: Catheter ablation may be considered. (...
...le 2b. Indications for Atrial Fibrillati...
...ongestive heart failu...
...reasonable to use similar indication...
...patients (>75 years of age)...
...s reasonable to use similar indications for AF a...
...trophic cardiomyopat...
...onable to use similar indications for AF ablatio...
...ung patients...
...e to use similar indications for AF ablat...
...achy-brady synd...
...asonable to offer AF ablation as an...
Athletes with...
It is reasonable to offer high-level athletes AF...
...eter ablation may be considered in selec...
...heter ablation may be considered in select...
...2c. Indications for Concomitant Open (such as...
...Surgical ablation is recommended. (I, B-NR)573...
...ersistent: Surgical ablation is recommen...
...ersistent: Surgical ablation is recommended. (I,...
...ysmal: Surgical ablation is recommended. (I,...
...ent: Surgical ablation is recommended. (...
...tanding persistent: Surgical ablation is...
...2d. Indications for Concomitant Closed (such as CA...
Paroxysmal: Surgical ablation is recommende...
...urgical ablation is recommended. (I, B-N...
...tanding persistent: Surgical ablation is...
...l: Surgical ablation is reasonable. (IIa,...
...gical ablation is reasonable. (IIa, B-N...
...ong-standing persistent: Surgical ablation i...
...tions for Stand-Alone and Hybrid Surgical Ablat...
...: Stand-alone surgical ablation can be cons...
...d-alone surgical ablation is reasonable fo...
...ong-standing persistent: Stand-alone s...
...able to apply the indications for st...
Treatment
Treatme...
...Atrial Fibrillation Ablation: Strategies, Techniq...
...tion of the PVs is recommended during all...
...hievement of electrical isolation re...
...V reconnection for 20 minutes following initial...
...dministration of adenosine 20 minu...
...of a pace-capture (pacing along the ablation l...
...ion of exit block may be considered. (IIb, B-N...
...e patient has a history of typical...
...inear ablation lesions are applied, op...
...ducible focal trigger that initiates AF is...
...AF ablation with a force-sensing RF abl...
Posterior wall isolation might be considered...
...on of high-dose isoproterenol to screen...
...nant excitation frequency (DF)-based ablation...
The usefulness of creating linear ablatio...
...of linear ablation lesions in the abse...
...ness of mapping and ablation of areas...
...efulness of ablation of complex fraction...
...he usefulness of ablation of rotational activi...
...of ablation of autonomic ganglia...
...t loss can be useful for patients w...
...s reasonable to consider a patient’s body mass i...
...onable to screen for signs and symptoms...
...eep apnea can be useful for patients w...
...of discontinuation of antiarrhythmic d...
...f initiation or continuation of antia...
...ul identification of the PV ostia is mandatory to...
...ended that RF power be reduced when c...
...reasonable to use an esophageal temperature probe...
...able 4. Anticoagulation Strategies: Pre-,...
...patients undergoing AF catheter ablat...
...patients undergoing AF catheter ablat...
...undergoing AF catheter ablation who hav...
...oagulation guidelines that pertain to cardio...
...r patients anticoagulated with a NOAC prior t...
...of a transesophageal echocardiogram (TEE) in pati...
...rmance of a TEE in patients who present f...
...iac echocardiography to screen for atrial thr...
...should be administered prior to or imm...
...stration of protamine following AF catheter ablati...
...who are not therapeutically anticoagulated prior...
...mic anticoagulation with warfarin o...
...AF anticoagulation guidelines is recommended for...
...cisions regarding continuation of systemic...
...tients who have not been anticoagulated...
...s in whom discontinuation of anticoagulation is be...
...5. Signs and Symptoms Following AF Ablati...
...6. Types of Ambulatory Cardiac Monitorin...
...ions of Complications Associated wit...
...dence, Prevention, Diagnosis, and Treatment of...
...Anatomical Drawings of the Heart Relevant...
...2. Posterior Perspective of the Left Atrium...
...chematic Drawing Showing Various Hypotheses...
...e 4. Structure and Mechanisms of AF...
...nisms of Atrial Flutter and Atrial Tachy...
...tic of Common Lesion Sets Employed in AF Ablat...
...igure 7. Indications for Catheter Ablation of Sy...
...Indications for Surgical Ablation of AF — C...
...atheter Ablation of AF Using Either RF E...