Ileana L. Piña, MD, MPH; Hugh G. Calkins, MD

Disclosures

November 04, 2013

In This Article

Who Is a Candidate for Ablation?

Dr. Piña: Clinicians may say that they are going to refer their patients for ablation after they have tried the usual. You gave them digoxin, you gave them a beta-blocker, you gave them amiodarone. And they haven't converted. Who should be entered into an ablation type of study?

Dr. Calkins: Who should get catheter ablation of AF? Despite this study, there is widespread agreement, and the HRS Expert Consensus Statement[2] clearly states that a desire to stop anticoagulation is not an appropriate indication for AF ablation. AF ablation is done to improve quality of life. That is the only proof we have. Yes, it may make people live longer. Yes, it may prevent strokes. Yes, it may reduce dementia. Yes, it may reduce heart failure. But the only proven benefit today is that if you have an AF ablation and the procedure is successful, there is significant improvement in quality of life.

Dr. Piña: So the patients feel better?

Dr. Calkins: Yes. If someone has asymptomatic AF, it would be inappropriate to do an AF ablation. If you look at the HRS Expert Consensus Statement, AF ablation is only indicated if someone has AF and an antiarrhythmic drug has failed, particularly if it is paroxysmal AF. That is an appropriate indication for AF ablation. However, in someone with no symptoms, that is not even mentioned as an indication for AF ablation. It would be inappropriate because the only reason you are doing it is for theoretical benefits that are unproven, and the procedure is not without risk.

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