2017 Consensus Statement on Atrial Fibrillation Ablation

Authors:
Calkins H, Hindricks G, Cappato R, et al.
Citation:
2017 HRS/EHRA/ECAS/APHRS/SOLAECE Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation. Heart Rhythm 2017;Sep 15:[Epub ahead of print].

The following are 10 points to remember from this expert consensus statement on atrial fibrillation (AF) ablation:

  1. There is strong evidence that AF ablation improves quality of life and reasonable evidence that it improves left ventricular function in patients with heart failure. Whether the risk of mortality, stroke, or dementia is affected still is unclear.
  2. In patients with symptomatic paroxysmal AF, catheter ablation (CA) is recommended if there has not been an acceptable response to ≥1 rhythm-control drug and is reasonable prior to drug therapy.
  3. CA of symptomatic persistent AF is reasonable whether or not the patient has been treated with a rhythm-control drug.
  4. In patients with longstanding persistent AF, CA may be considered either before or after treatment with a rhythm-control drug.
  5. It is reasonable to use similar recommendations for AF CA in patients with heart failure, hypertrophic cardiomyopathy, or age >75 years.
  6. In patients with tachy-brady syndrome, CA is a reasonable alternative to pacemaker implantation.
  7. CA for asymptomatic AF may be considered, but requires additional discussion with the patient because the benefit of CA in asymptomatic patients is uncertain.
  8. Anticoagulation with warfarin or a novel oral anticoagulant is recommended for at least 2 months post-CA of AF.
  9. The decision to discontinue anticoagulation beyond 2 months post-CA should be based on the patient’s stroke risk profile, not on the clinical outcome of the procedure.
  10. Continuous or frequent monitoring to detect recurrent AF should be considered if anticoagulation is discontinued post-ablation due to patient preference.

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Anticoagulation Management and Atrial Fibrillation, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Aortic Surgery, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Acute Heart Failure, Interventions and Structural Heart Disease, Sleep Apnea

Keywords: Anticoagulants, Arrhythmias, Cardiac, Atrial Fibrillation, Bradycardia, Cardiac Surgical Procedures, Cardiomyopathy, Hypertrophic, Catheter Ablation, Consensus, Dementia, Heart Failure, Pacemaker, Artificial, Patient Preference, Quality of Life, Stroke, Tachycardia, Ventricular Function, Left, Warfarin


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