What are the guideline sources, guidelines and references for Atrial fibrillation ablation ?
Guideline sources The following summarized guidelines for the evaluation and management of atrial fibrillation ablation are prepared by our editorial team based on guidelines from the Latin American Heart Rhythm Society (SOLAECE/ECAS/APHRS/EHRA/HRS 2017). 1 2 2 3 4 Definition AF ablation is the treatment strategy for the maintenance of sinus rhythm and improvement of quality of life in patients with symptomatic AF. 2 Epidemiology AF ablation is indicated in patients with paroxysmal AF and persistent AF. 3 Disease course Catheter ablation of AF goal is to eliminate triggers and/or modify the arrhythmogenic substrate by pulmonary vein isolation in addition to different strategies using various technologies such as electro-anatomical mapping system and cryo-balloon technology. AF ablation maintains sinus rhythm, improves exercise capacity, quality of life, morbidity (stroke), and mortality. 4 Prognosis and risk of recurrence https://web.pathway.md/diseases/reczy5g2bZ5EnxkfY 1/4 6/23/23, 3:15 AM Atrial fibrillation ablation Pathway og os s a d s o ecu e ce AF ablation is associated with lower mortality risk (HR 0.50, 95% CI 0.37-0.62) and stroke/TIA risk (HR 0.62, 95% CI 0.44-0.86). 2 Guidelines 1. Diagnostic investigations Echocardiography: Consider TEE before catheter ablation in patients who are in AF at the time of the procedure and have been receiving therapeutic anticoagulation for 3 weeks or longer. C Consider TEE before catheter ablation in patients who are in sinus rhythm and at the time of the procedure and have not been receiving therapeutic anticoagulation for 3 weeks or longer. C Pre-procedural mapping: insufficient evidence to assess the usefulness of voltage mapping or MRI to identify areas of abnormal myocardial tissue and guide ablation in patients with persistent or long-standing persistent AF. I 2. Medical management Pre-procedural anticoagulation: perform AF catheter ablation without interruption of warfarin or dabigatran in patients who have been anticoagulated with these agents. A Show 2 more Per-procedural anticoagulation: administer heparin prior to or immediately following transseptal puncture during AF catheter ablation procedures, and adjust to achieve and maintain an ACT 300 s. B Post-procedural anticoagulation: adhere to AF anticoagulation guidelines for patients who have undergone an AF ablation procedure, regardless of the apparent success or failure of the procedure. B Management of antiarrythmics: insufficient evidence to assess the usefulness of discontinuation of antiarrhythmic drug therapy before AF ablation in an attempt to improve long- term outcomes. I Management of sleep apnea: consider screening for signs and symptoms of sleep apnea when evaluating a patient for AF ablation, and obtaining a sleep evaluation if sleep apnea is suspected. C 3. Nonpharmacologic interventions Weight loss: consider advising weight loss to patients who are being evaluated to undergo an AF ablation procedure, as part of a comprehensive risk factor management strategy. C https://web.pathway.md/diseases/reczy5g2bZ5EnxkfY 2/4 6/23/23, 3:15 AM Atrial fibrillation ablation Pathway 4. Therapeutic procedures Indications for catheter ablation (prior to initiation of medication): consider catheter ablation for patients with paroxysmal AF prior to initiation of antiarrythmic medication. C Indications for catheter ablation (failure of antiarrhythmic medication): Perform catheter ablation for patients with paroxysmal AF refractory to antiarrythmic medication. A Consider catheter ablation for patients with persistent AF refractory to antiarrythmic medication. C Pulmonary vein isolation: perform electrical isolation of the pulmonary veins during all AF ablation procedures. A Other ablation techniques: perform a linear ablation of the cavotricuspid isthmus in patients with a history of typical atrial flutter, or if typical atrial flutter is induced at the time of AF ablation. B 5. Perioperative care Safety precautions: identify the pulmonary vein ostia carefully to avoid ablation within the pulmonary veins. B Fractionated atrial electrograms: insufficient evidence to assess the usefulness of ablation of complex fractionated atrial electrograms as an initial or repeat ablation strategy in patients with persistent and long-standing AF. I High-dose isoproterenol: consider administration of high-dose isoproterenol to screen for and then ablate non-pulmonary vein triggers during initial or repeat AF ablation procedures in patients with paroxysmal, persistent, or long-standing persistent AF. C 6. Surgical interventions Indications for surgical ablation (prior to initiation of medication): perform surgical ablation in patients with paroxysmal AF undergoing concomitant open cardiac surgery for other indications. B Indications for surgical ablation (failure of antiarrhythmic medication): perform surgical ablation of AF in patients with paroxysmal AF refractory to antiarrythmic medications who are undergoing concomitant open cardiac surgery for other indications. B Indications for surgical ablation (stand-alone procedure): Consider stand-alone surgical ablation for paroxysmal AF in patients who have failed one or more attempts at catheter ablation and also for those who are intolerant or refractory to antiarrhythmic drug therapy and prefer a surgical approach. C Consider stand-alone surgical ablation for persistent AF in patients who have failed one or more attempts at catheter ablation and for those patients who prefer a surgical approach. C https://web.pathway.md/diseases/reczy5g2bZ5EnxkfY 3/4 6/23/23, 3:15 AM Atrial fibrillation ablation Pathway 7. Specific circumstances High-level athletes: consider AF ablation as first-line therapy for high-level athletes with AF, due to the negative effects of medications on athletic performance. C Young patients (<45 years of age): consider using similar indications for AF ablation in young patients with AF < 45 years of age, as in older patients. C Elderly patients (> 75 years of age): consider using similar indications for AF ablation in selected older patients with AF as in younger patients. C Patients with asymptomatic disease: Consider catheter ablation in select patients with asymptomatic, paroxysmal AF. C Consider catheter ablation in select patients with asymptomatic, persistent AF. C Patients with congestive heart failure: consider AF ablation in selected patients with HF using the same indications as in patients without HF. C Patients with hypertrophic cardiomyopathy: consider using similar indications for AF ablation in selected patients with hypertrophic cardiomyopathy as in patients without hypertrophic cardiomyopathy. C Patients with tachy-brady syndrome: consider AF ablation as an alternative to pacemaker implantation in patients with tachycardia-bradycardia syndrome. C References 1. 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. J Arrhythm. 2017 Oct;33 5 369 409. Open 2. Xue-Yuan Guo, Chang-Sheng Ma. Atrial Fibrillation Ablation: Indications, Outcomes, Complications, and Future Directions. 2017 Aug 20;130 16 1891 1893.2017 Aug 20;130 16 1891 1893. Open 3. Nebojsa Mujovic, Milan Marinkovic, Radoslaw Lenarczyk et al. Catheter Ablation of Atrial Fibrillation: An Overview for Clinicians. 2017 Aug;34 8 1897 1917.2017 Aug;34 8 1897 1917. Open 4. Alicia Darge, Matthew R Reynolds, Joseph J Germano. Advances in atrial fibrillation ablation. 2009 May;21 5 247 54.2009 May;21 5 247 54. Open https://web.pathway.md/diseases/reczy5g2bZ5EnxkfY 4/4