What are the guidelines for catheter ablation to achieve rhythm control in patients with atrial fibrillation (Afib) (AF)?

Updated: Apr 09, 2019
  • Author: Lawrence Rosenthal, MD, PhD, FACC, FHRS; Chief Editor: Jeffrey N Rottman, MD  more...
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Answer

Ablation (catheter based, surgical, or hybrid) for AF can also be performed for achieving rhythm-control. The ACC/AHA/HRS guidelines recommend catheter ablation in the following settings [1] :

  • It is useful for patients with symptomatic paroxysmal AF who are intolerant of, or whose condition is refractory to, at least one class I or III antiarrhythmic medication when a rhythm-control strategy is desired (class I, level of evidence [LOE]: A).

  • It is reasonable as a treatment for certain patients with symptomatic persistent AF who are intolerant of, or whose condition is refractory to, at least one class I or III antiarrhythmic medication (class IIa, LOE: A).

  • It is a reasonable initial strategy for rhythm control prior to using antiarrhythmic drug therapy for patients with recurrent symptomatic paroxysmal AF (class IIa, LOE: B).

Surgical ablation of AF is also an option for patients with AF undergoing other cardiac surgery and for those patients in whom pharmacologic and catheter-based procedures are ineffective or contraindicated. AF ablation may be superior to AV nodal ablation and biventricular pacing in heart failure patients but is technically difficult and demanding, and the widespread applicability of ablation in this population of patients is uncertain.

In the first randomized clinical trial comparing the efficacy and safety of catheter ablation versus minimally invasive surgical ablation during a 12-month follow-up, Boersma et al found that patients with AF who had a dilated left atrium and hypertension or who failed prior AF catheter ablation, surgical ablation was superior in achieving freedom from left atrial arrhythmias after 12 months of follow-up; however, the procedural adverse event rate was found to be significantly higher with surgical ablation than for catheter ablation, primarily postoperative pneumothorax, major bleeding, and an increased need for permanent pacing. [117]

Go to Catheter Ablation for complete information on this topic.


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