11/27 7/6/23, 2:49 PM Catheter ablation for the treatment of atrial fibrillation: Technical considerations for non-electrophysiologists - UpToDate POSTPROCEDURAL ISSUES After the procedure, patients usually remain supine for a fixed period (usually two to four hours) following sheath removal to promote hemostasis at the venous puncture sites. Vascular closure devices allow for more rapid hemostasis and shorter time to ambulation. Most centers keep patients overnight following the procedure. Same-day discharge has become increasingly common given the shorter procedure times and use of venous closure techniques [45,46]. Post-discharge medications Oral anticoagulation is usually continued [47] for at least two months to ensure that the increased risk of embolization associated with the procedure has returned to a baseline risk, regardless of CHADS VA Sc score. This also allows for adequate time 2 2 to document an absence of recurrence of AF for those patients in whom practitioners and patients are contemplating discontinuing anticoagulation [48]. Importantly, there are no randomized data on the safety of discontinuing anticoagulation post-ablation for patients who have presumably maintained sinus rhythm. The risk of AF recurrence, the recognized proportional increase in the burden of asymptomatic AF, and the uncertainty surrounding the causal association between the arrhythmia itself and stroke all support the recommendation to risk stratify patients for oral anticoagulation use based on CHA DS -VASc no differently than if an 2 2 ablation had not been performed. (See "Catheter ablation to prevent recurrent atrial fibrillation: Anticoagulation", section on 'Postprocedural anticoagulation'.) Antiarrhythmic medications may or may not be continued after the procedure. Our preference is to stop them after the procedure. Patients in whom consideration should be given to continuing them include patients with long-standing persistent AF or patients with debilitating AF symptoms. Post-discharge follow-up At the time of discharge, patients are given instructions on activity and what potential complications to look for. They should refrain from heavy physical activity, including exercise and weight lifting, for the week post-procedure to allow for complete healing of the vascular access sites. Baths should also be avoided for one week to reduce infection risk. In patients without identified post-procedural complications such as vascular access site problems, we wait three months to reevaluate the patient [9] (see 'Complications' below). Patients with potential complications should be seen immediately. Patients who develop symptoms should contact either their primary care physician, general cardiologist, or electrophysiologist to discuss the need for early evaluation. Yearly follow-up with a physician thereafter is also recommended. These ongoing interactions with the medical profession allow the patient's clinical status to be evaluated, including an https://www.uptodate.com/contents/catheter-ablation-for-the-treatment-of-atrial-fibrillation-technical-considerations-for-non-electrophysiologists/print 12/27 7/6/23, 2:49 PM Catheter ablation for the treatment of atrial fibrillation: Technical considerations for non-electrophysiologists - UpToDate assessment of the presence or absence of AF, as well as their stroke risk profile and anticoagulation needs. These interactions also provide an opportunity to focus on the treatment of associated diseases and lifestyle modifications [9]. Routine ECG should be performed at the time of follow-up visits, and more intense monitoring may be performed as dictated by patient symptoms and the clinical impact of AF detection [41]. Evaluation for recurrent atrial fibrillation The primary purpose of the first follow-up visit around the three-month mark is to determine the success of the procedure. Screening for post- procedure AF is discussed separately. (See "Atrial fibrillation: Catheter ablation", section on 'Follow-up'.) In general, we do not evaluate the patient for the presence of AF prior to three months, as early episodes do not necessarily predict the long-term success or failure of the procedure. They can often be managed with antiarrhythmic drugs or cardioversion. Repeat ablation during this time is rarely necessary. During this three-month healing phase, there is resolution of inflammation and consolidation of lesion formation. This time period is referred to in clinical research trials as the "post-procedure blanking period." Anticoagulants are continued throughout this period regardless of the patient's CHA DS -VASc score ( table 1). Antiarrhythmic drugs and/or electrical cardioversion 2 2 are used during this blanking period at the discretion of the treating physician and usually reserved for those with debilitating symptoms or recurrent persistent AF. Success rates The success rate of AF ablation is dependent on multiple factors including patient selection, technique, definition of success, and the intensity and duration of rhythm monitoring post-ablation. For research purposes, the primary endpoint of AF ablation trials is freedom from recurrent AF/ atrial tachycardia (AT) defined as the absence of any recurrent AF/AT >30 seconds without antiarrhythmic drugs. Using this strict definition, the one-year success rate for paroxysmal AF is approximately 70 to 80 percent and 60 to 70 percent for persistent AF at most experienced centers. However, a greater proportion of patients will derive an improvement in AF-related symptoms from ablation, and studies using implantable cardiac monitors or other devices that can record all episodes of AF have shown an AF burden reduction of over 98 percent [49]. (See "Maintenance of sinus rhythm in atrial fibrillation: Catheter ablation versus antiarrhythmic drug therapy", section on 'Patients with prior antiarrhythmic drug treatment'.) Complications Complications are discussed in detail separately. (See "Atrial fibrillation: Catheter ablation", section on 'Complications'.) https://www.uptodate.com/contents/catheter-ablation-for-the-treatment-of-atrial-fibrillation-technical-considerations-for-non-electrophysiologists/print 13/27 7/6/23, 2:49 PM Catheter ablation for the treatment of atrial fibrillation: Technical considerations for non-electrophysiologists - UpToDate SOCIETY GUIDELINE LINKS Links to society and government-sponsored guidelines from selected countries and regions around the world are provided separately. (See "Society guideline links: Atrial fibrillation" and "Society guideline links: Arrhythmias in adults".) INFORMATION FOR PATIENTS UpToDate offers two types of patient education materials, The Basics and Beyond the Basics. th th The Basics patient education pieces are written in plain language, at the 5 to 6 grade reading level, and they answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials. Beyond the Basics patient education pieces are longer, more th th sophisticated, and more detailed. These articles are written at the 10 to 12 grade reading level and are best for patients who want in-depth information and are comfortable with some medical jargon. Here are the patient education articles that are relevant to this topic. We encourage you to print or e-mail these topics to your patients. (You can also locate patient education articles on a variety of subjects by searching on patient info and the keyword(s) of interest.) Beyond the Basics topics (see "Patient education: Atrial fibrillation (Beyond the Basics)") SUMMARY AND RECOMMENDATIONS Pulmonary vein origin of atrial fibrillation (AF) The primary trigger for most episodes of AF involves electrical discharges within one or more pulmonary veins (PVs) ( figure 1). A principal goal of any procedure is to reduce the frequency of AF and electrically isolate the PVs so that these discharges do not activate atrial tissue. (See 'Introduction' above.) Clinical goal of catheter ablation (CA) The major clinical goal of CA is a reduction in AF- related symptoms. CA is superior to medical therapy at improving a patient's quality of life. Therefore, it is generally reserved for individuals with symptoms attributable to the arrhythmia, which most often include palpitations, shortness of breath, or generalized fatigue. Even if they have no AF-related symptoms, older individuals with early AF (duration <1 year) and additional cardiovascular conditions also benefit from therapies aimed at maintaining sinus rhythm; these therapies include CA. (See 'Patient selection' above.) https://www.uptodate.com/contents/catheter-ablation-for-the-treatment-of-atrial-fibrillation-technical-considerations-for-non-electrophysiologists/print 14/27 7/6/23, 2:49 PM Catheter ablation for the treatment of atrial fibrillation: Technical considerations for non-electrophysiologists - UpToDate Role of shared decision-making AF ablation is a complicated procedure with defined risks. Shared decision-making among the patient, primary care physician, general cardiologist, and electrophysiologist is essential. Ablation techniques Radiofrequency, cryothermal, and laser energy are the approved energy sources for CA of AF. (See 'Energy sources' above.) Various methods of CA have been used, and most focus on isolating the triggers in the PVs from the vulnerable substrate in the left atrium. The most common technique is circumferential PV isolation. (See 'Pulmonary vein isolation' above.) Complications Treating physicians should be aware of three serious complications that can occur postprocedurally: pericardial effusion causing cardiac tamponade, an atrial esophageal fistula, and PV stenosis ( table 2 and table 3). (See "Atrial fibrillation: Catheter ablation", section on 'Complications'.) Use of UpToDate is subject to the Terms of Use. REFERENCES 1. Mark DB, Anstrom KJ, Sheng S, et al. Effect of Catheter Ablation vs Medical Therapy on Quality of Life Among Patients With Atrial Fibrillation: The CABANA Randomized Clinical Trial. JAMA 2019; 321:1275. 2. Calkins H, Hindricks G, Cappato R, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: Executive summary. Heart Rhythm 2017; 14:e445. 3. Kirchhof P, Camm AJ, Goette A, et al. Early Rhythm-Control Therapy in Patients with Atrial Fibrillation. N Engl J Med 2020; 383:1305. 4. Larsson SC, Drca N, Wolk A. 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General anesthesia reduces the prevalence of pulmonary vein reconnection during repeat ablation when compared with conscious sedation: results from a randomized study. Heart Rhythm 2011; 8:368. 22. Sivasambu B, Hakim JB, Barodka V, et al. Initiation of a High-Frequency Jet Ventilation Strategy for Catheter Ablation for Atrial Fibrillation: Safety and Outcomes Data. JACC Clin Electrophysiol 2018; 4:1519. 23. Briceno DF, Villablanca PA, Lupercio F, et al. Clinical Impact of Heparin Kinetics During Catheter Ablation of Atrial Fibrillation: Meta-Analysis and Meta-Regression. J Cardiovasc Electrophysiol 2016; 27:683. 24. Nagao T, Inden Y, Yanagisawa S, et al. Differences in activated clotting time among uninterrupted anticoagulants during the periprocedural period of atrial fibrillation ablation. Heart Rhythm 2015; 12:1972. 25. Str ker E, de Asmundis C, Kupics K, et al. Value of ultrasound for access guidance and detection of subclinical vascular complications in the setting of atrial fibrillation cryoballoon ablation. Europace 2019; 21:434. 26. Yamagata K, Wichterle D, Roub cek T, et al. Ultrasound-guided versus conventional femoral venipuncture for catheter ablation of atrial fibrillation: a multicentre randomized efficacy and safety trial (ULTRA-FAST trial). Europace 2018; 20:1107. 27. Kurotobi T, Iwakura K, Inoue K, et al. Multiple arrhythmogenic foci associated with the development of perpetuation of atrial fibrillation. Circ Arrhythm Electrophysiol 2010; 3:39. 28. Ha ssaguerre M, Ja s P, Shah DC, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 1998; 339:659. 29. Chen SA, Hsieh MH, Tai CT, et al. Initiation of atrial fibrillation by ectopic beats originating from the pulmonary veins: electrophysiological characteristics, pharmacological responses, and effects of radiofrequency ablation. Circulation 1999; 100:1879. 30. Tsai CF, Tai CT, Hsieh MH, et al. Initiation of atrial fibrillation by ectopic beats originating from the superior vena cava: electrophysiological characteristics and results of https://www.uptodate.com/contents/catheter-ablation-for-the-treatment-of-atrial-fibrillation-technical-considerations-for-non-electrophysiologists/print 17/27 7/6/23, 2:49 PM Catheter ablation for the treatment of atrial fibrillation: Technical considerations for non-electrophysiologists - UpToDate radiofrequency ablation. Circulation 2000; 102:67. 31. Lee G, Spence S, Teh A, et al. High-density epicardial mapping of the pulmonary vein-left atrial junction in humans: insights into mechanisms of pulmonary vein arrhythmogenesis. Heart Rhythm 2012; 9:258. 32. Pappone C, Rosanio S, Oreto G, et al. Circumferential radiofrequency ablation of pulmonary vein ostia: A new anatomic approach for curing atrial fibrillation. Circulation 2000; 102:2619. 33. Pappone C, Santinelli V. The who, what, why, and how-to guide for circumferential pulmonary vein ablation. J Cardiovasc Electrophysiol 2004; 15:1226. 34. Oral H, Knight BP, Tada H, et al. Pulmonary vein isolation for paroxysmal and persistent atrial fibrillation. Circulation 2002; 105:1077. 35. Reddy VY, Shah D, Kautzner J, et al. The relationship between contact force and clinical outcome during radiofrequency catheter ablation of atrial fibrillation in the TOCCATA study. Heart Rhythm 2012; 9:1789. 36. Neuzil P, Reddy VY, Kautzner J, et al. Electrical reconnection after pulmonary vein isolation is contingent on contact force during initial treatment: results from the EFFICAS I study. Circ Arrhythm Electrophysiol 2013; 6:327. 37. Bourier F, Duchateau J, Vlachos K, et al. High-power short-duration versus standard radiofrequency ablation: Insights on lesion metrics. J Cardiovasc Electrophysiol 2018; 29:1570. 38. Macle L, Khairy P, Weerasooriya R, et al. Adenosine-guided pulmonary vein isolation for the treatment of paroxysmal atrial fibrillation: an international, multicentre, randomised superiority trial. Lancet 2015; 386:672. 39. Kobori A, Shizuta S, Inoue K, et al. Adenosine triphosphate-guided pulmonary vein isolation for atrial fibrillation: the UNmasking Dormant Electrical Reconduction by Adenosine TriPhosphate (UNDER-ATP) trial. Eur Heart J 2015; 36:3276. 40. Ghanbari H, Jani R, Hussain-Amin A, et al. Role of adenosine after antral pulmonary vein isolation of paroxysmal atrial fibrillation: A randomized controlled trial. Heart Rhythm 2016; 13:407. 41. Calkins H, Kuck KH, Cappato R, et al. 2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. Europace 2012; 14:528. 42. Lin JL, Lai LP, Tseng YZ, et al. Global distribution of atrial ectopic foci triggering recurrence of atrial tachyarrhythmia after electrical cardioversion of long-standing atrial fibrillation: a bi- https://www.uptodate.com/contents/catheter-ablation-for-the-treatment-of-atrial-fibrillation-technical-considerations-for-non-electrophysiologists/print 18/27 7/6/23, 2:49 PM Catheter ablation for the treatment of atrial fibrillation: Technical considerations for non-electrophysiologists - UpToDate atrial basket mapping study. J Am Coll Cardiol 2001; 37:904. 43. Nademanee K, McKenzie J, Kosar E, et al. A new approach for catheter ablation of atrial fibrillation: mapping of the electrophysiologic substrate. J Am Coll Cardiol 2004; 43:2044. 44. Narayan SM, Patel J, Mulpuru S, Krummen DE. Focal impulse and rotor modulation ablation of sustaining rotors abruptly terminates persistent atrial fibrillation to sinus rhythm with elimination on follow-up: a video case study. Heart Rhythm 2012; 9:1436. 45. Bartoletti S, Mann M, Gupta A, et al. Same-day discharge in selected patients undergoing atrial fibrillation ablation. Pacing Clin Electrophysiol 2019; 42:1448. 46. Natale A, Mohanty S, Liu PY, et al. Venous Vascular Closure System Versus Manual Compression Following Multiple Access Electrophysiology Procedures: The AMBULATE Trial. JACC Clin Electrophysiol 2020; 6:111. 47. Eitel C, Koch J, Sommer P, et al. Novel oral anticoagulants in a real-world cohort of patients undergoing catheter ablation of atrial fibrillation. Europace 2013; 15:1587. 48. Karasoy D, Gislason GH, Hansen J, et al. Oral anticoagulation therapy after radiofrequency ablation of atrial fibrillation and the risk of thromboembolism and serious bleeding: long- term follow-up in nationwide cohort of Denmark. Eur Heart J 2015; 36:307. 49. Lohrmann G, Kaplan R, Ziegler PD, et al. Atrial fibrillation ablation success defined by duration of recurrence on cardiac implantable electronic devices. J Cardiovasc Electrophysiol 2020; 31:3124. Topic 95704 Version 21.0 https://www.uptodate.com/contents/catheter-ablation-for-the-treatment-of-atrial-fibrillation-technical-considerations-for-non-electrophysiologists/print 19/27 7/6/23, 2:49 PM Catheter ablation for the treatment of atrial fibrillation: Technical considerations for non-electrophysiologists - UpToDate GRAPHICS Junction of left atrium and pulmonary veins The common pattern of the superficial myocardial fibers of the left atrium (posterior aspect). A main circular fascicle (a, a', a", and a"') runs peripherally around the area of the openings of the pulmonary veins. An interatrial fascicle (b) runs between the right (RA) and the left (LA) atrium. Some fibers (c) descend from the left atrium into the left part (a') of the main circular fascicle. Circular fibers leaving the main fascicle turn around the openings of the pulmonary veins, forming sphincter-like structures; other fibers extend over the https://www.uptodate.com/contents/catheter-ablation-for-the-treatment-of-atrial-fibrillation-technical-considerations-for-non-electrophysiologists/print 20/27 7/6/23, 2:49 PM Catheter ablation for the treatment of atrial fibrillation: Technical considerations for non-electrophysiologists - UpToDate veins as myocardial sleeves. Loops of fibers coming from the atrium are seen over the right superior pulmonary vein (RSPV) and returning to the atrium. Oblique, vertical (e), and transverse (f, f') fascicles of fibers are also seen on the posterior atrial surface. LA: left atrium; RA: right atrium; SVC: superior vena cava; IVC: inferior vena cava; RSPV: right superior pulmonary vein; LSPV: left superior pulmonary vein; RIPV: right inferior pulmonary vein; LIPV: left inferior pulmonary vein. From: Nathan H, Eliakim M. The junction between the left atrium and the pulmonary veins. Circulation 1966; 34:412. DOI: 10.1161/01.cir.34.3.412. Copyright 1966. Adapted with permission from Wolters Kluwer Health. Unauthorized reproduction of this material is prohibited. Graphic 127240 Version 3.0 https://www.uptodate.com/contents/catheter-ablation-for-the-treatment-of-atrial-fibrillation-technical-considerations-for-non-electrophysiologists/print 21/27 7/6/23, 2:49 PM Catheter ablation for the treatment of atrial fibrillation: Technical considerations for non-electrophysiologists - UpToDate Clinical risk factors for stroke, transient ischemic attack, and systemic embolism in the CHA DS -VASc score 2 2 (A) The risk factor-based approach expressed as a point based scoring system, with the acronym CHA DS -VASc 2 2 (NOTE: maximum score is 9 since age may contribute 0, 1, or 2 points) CHA DS -VASc risk factor Points 2 2 Congestive heart failure +1 Signs/symptoms of heart failure or objective evidence of reduced left ventricular ejection fraction Hypertension +1 Resting blood pressure >140/90 mmHg on at least 2 occasions or current antihypertensive treatment Age 75 years or older +2 Diabetes mellitus +1 Fasting glucose >125 mg/dL (7 mmol/L) or treatment with oral hypoglycemic agent and/or insulin Previous stroke, transient ischemic attack, or thromboembolism +2 Vascular disease +1 Previous myocardial infarction, peripheral artery disease, or aortic plaque Age 65 to 74 years +1 Sex category (female) +1 (B) Adjusted stroke rate according to CHA DS -VASc score 2 2 CHA DS -VASc score Patients Stroke and 2 2 (n = 73,538) thromboembolism event rate at 1-year follow-up (%) 0 6369 0.78 1 8203 2.01 2 12,771 3.71 3 17,371 5.92 4 13,887 9.27 5 8942 15.26 https://www.uptodate.com/contents/catheter-ablation-for-the-treatment-of-atrial-fibrillation-technical-considerations-for-non-electrophysiologists/print 22/27 7/6/23, 2:49 PM Catheter ablation for the treatment of atrial fibrillation: Technical considerations for non-electrophysiologists - UpToDate 6 4244 19.74 7 1420 21.50 8 285 22.38 9 46 23.64 CHA DS -VASc: Congestive heart failure, Hypertension, Age ( 75; doubled), Diabetes, Stroke (doubled), Vascular disease, Age (65 to 74), Sex. 2 2 Part A from: Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial brillation developed in collaboration with EACTS. Europace 2016; 18(11):1609-1678. By permission of Oxford University Press on behalf of the European Society of Cardiology. Copyright 2016 Oxford University Press. Available at: www.escardio.org/. Graphic 83272 Version 29.0 https://www.uptodate.com/contents/catheter-ablation-for-the-treatment-of-atrial-fibrillation-technical-considerations-for-non-electrophysiologists/print 23/27 7/6/23, 2:49 PM Catheter ablation for the treatment of atrial fibrillation: Technical considerations for non-electrophysiologists - UpToDate Intraprocedural risks of ablation for atrial fibrillation Complication Incidence Diagnostic testing Air embolism <1% Nothing or cardiac catheterization Asymptomatic cerebral emboli 2 to 15% Brain MRI Cardiac tamponade 0.2 to 5% Echocardiography Coronary stenosis/occlusion <0.1% Cardiac catheterization Death <0.1 to 0.4% N/A Mitral valve entrapment <0.1% Echocardiography Permanent phrenic nerve 0 to 0.4% Chest radiograph, sniff test paralysis Radiation injury <0.1% None Stroke or TIA 0 to 2% Head CT/MRI, cerebral angiography Vascular complications 0.2 to 1.5% Vascular ultrasound, CT scan MRI: magnetic resonance imaging; TIA: transient ischemic attack; CT: computed tomography. Adapted from: Calkins H, Hindricks G, Cappato R, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial brillation: Executive summary. J Interv Card Electrophysiol 2017; 50:1. Available at: https://link.springer.com/article/10.1007%2Fs10840-017-0277-z. Copyright 2017 The Authors. Reproduced under the terms of the Creative Commons Attribution License 4.0. Graphic 127125 Version 1.0 https://www.uptodate.com/contents/catheter-ablation-for-the-treatment-of-atrial-fibrillation-technical-considerations-for-non-electrophysiologists/print 24/27 7/6/23, 2:49 PM Catheter ablation for the treatment of atrial fibrillation: Technical considerations for non-electrophysiologists - UpToDate Signs and symptoms of complications of catheter ablation to prevent atrial fibrillation within a month post-ablation Sign/symptom Differential Suggested evaluation Back pain Musculoskeletal, retroperitoneal hematoma Physical exam, CT imaging Chest pain Pericarditis, pericardial effusion, coronary stenosis (ablation Physical exam, chest radiograph, ECG, related), pulmonary vein stenosis, musculoskeletal (after echocardiogram, stress test, cardiac catheterization, chest CT cardioversion), worsening reflux Cough Infectious process, bronchial Physical exam, chest irritation (mechanical, cryoballoon), pulmonary vein stenosis radiograph, chest CT Dysphagia Esophageal irritation (related to transesophageal Physical exam, chest CT, MRI echocardiography), atrioesophageal fistula Early satiety, nausea Gastric denervation Physical exam, gastric emptying study Fever Infectious process, pericarditis, atrioesophageal fistula Physical exam, chest radiograph, chest CT, urinalysis, laboratory blood work Fever, dysphagia, neurological Atrial esophageal fistula Physical exam, laboratory blood symptoms work, chest CT or MRI; avoid endoscopy with air insufflation Groin pain Pseudoaneurysm, AV fistula, Ultrasound of the groin, hematoma laboratory blood work; consider CT scan if ultrasound negative Hypotension Pericardial effusion/tamponade, bleeding, sepsis, persistent Echocardiography, laboratory blood work vagal reaction Hemoptysis Pulmonary vein stenosis or occlusion, pneumonia Chest radiograph, chest CT or MR scan, VQ scan Neurological symptoms Cerebral embolic event, atrial esophageal fistula Physical exam, brain imaging, chest CT or MRI Shortness of breath Volume overload, pneumonia, Physical exam, chest pulmonary vein stenosis, radiograph, chest CT, laboratory https://www.uptodate.com/contents/catheter-ablation-for-the-treatment-of-atrial-fibrillation-technical-considerations-for-non-electrophysiologists/print 25/27 7/6/23, 2:49 PM Catheter ablation for the treatment of atrial fibrillation: Technical considerations for non-electrophysiologists - UpToDate phrenic nerve injury blood work CT: computed tomography; ECG: electrocardiogram; MRI: magnetic resonance imaging; AV: atrioventricular. Adapted from: Calkins H, Hindricks G, Cappato R, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial brillation: Executive summary. J Interv Card Electrophysiol 2017; 50:1. Available at: https://link.springer.com/article/10.1007%2Fs10840-017-0277-z. Copyright 2017 The Authors. Reproduced under the terms of the Creative Commons Attribution License 4.0. Graphic 127127 Version 1.0 https://www.uptodate.com/contents/catheter-ablation-for-the-treatment-of-atrial-fibrillation-technical-considerations-for-non-electrophysiologists/print 26/27 7/6/23, 2:49 PM Catheter ablation for the treatment of atrial fibrillation: Technical considerations for non-electrophysiologists - UpToDate Contributor Disclosures Rod Passman, MD, MSCE Grant/Research/Clinical Trial Support: Abbott [Ablation]; AHA [Ablation]; NIH [Stroke prevention]. Consultant/Advisory Boards: Abbott [Ablation]; iRhythm [Monitoring]; Janssen [Atrial fibrillation detection]; Medtronic [Implantable cardiac monitors]. Speaker's Bureau: iRhythm [Monitoring]. All of the relevant financial relationships listed have been mitigated. Bradley P Knight, MD, FACC Grant/Research/Clinical Trial Support: Abbott [Electrophysiology]; Atricure [Electrophysiology]; Biosense Webster [Electrophysiology]; Biotronik [Electrophysiology]; Boston Scientific [Electrophysiology]; BSCI [Electrophysiology]; MDT [Electrophysiology]; Philips [Electrophysiology]. Consultant/Advisory Boards: Abbott [Electrophysiology]; Atricure [Electrophysiology]; Biosense Webster [Electrophysiology]; Biotronik [Electrophysiology]; Boston Scientific [Electrophysiology]; BSCI [Electrophysiology]; CVRx [Heart failure]; MDT [Electrophysiology]; Philips [Electrophysiology]; Sanofi [Arrhythmias]. Speaker's Bureau: Abbott [Electrophysiology]; Biosense Webster [Electrophysiology]; Biotronik [Electrophysiology]; Boston Scientific [Transeptal catheterization]; BSCI [Electrophysiology]; MDT [Electrophysiology]. All of the relevant financial relationships listed have been mitigated. N A Mark Estes, III, MD Consultant/Advisory Boards: Boston Scientific [Arrhythmias]; Medtronic [Arrhythmias]. All of the relevant financial relationships listed have been mitigated. Nisha Parikh, MD, MPH No relevant financial relationship(s) with ineligible companies to disclose. Contributor disclosures are reviewed for conflicts of interest by the editorial group. When found, these are addressed by vetting through a multi-level review process, and through requirements for references to be provided to support the content. Appropriately referenced content is required of all authors and must conform to UpToDate standards of evidence. Conflict of interest policy https://www.uptodate.com/contents/catheter-ablation-for-the-treatment-of-atrial-fibrillation-technical-considerations-for-non-electrophysiologists/print 27/27