HeartRhythm Online Editor Daniel P. Morin, MD, MPH, FHRS, interviews Hugh Calkins, MD
The 2017 Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation represents a complete rewrite of the 2012 HRS/EHRA/ECAS Expert Consensus Statement. This document provides updated definitions, mechanisms, and rationale for atrial fibrillation (AF) ablation and consensus recommendations concerning indications, strategies, techniques, and endpoints, technology and tools, and follow-up considerations for AF ablation. The document also provides definitions to be used in clinical trials and recommendations that will impact clinical trial design. The document was developed in joint partnership with EHRA, ECAS, APHRS, and SOLAECE. Collaborators on the document include STS, ACC, AHA, CHRS, JHRS, and SOBRAC.
This document features a clinician summary (an educational derivative product of the full document), a slide set (an educational tool for electrophysiologists, cardiologists, and other licensed health care practitioners), an Executive Summary, and an interview with Hugh Calkins, MD, FHRS, by HeartRhythm Online Editor Daniel P. Morin, MD, MPH, FHRS.
The Catheter and Surgical Ablation of Atrial Fibrillation pocket card, a valuable educational reference tool created in partnership with Guideline Central, is available across multiple platforms, including print, electronic media, and the Guideline Central mobile app. Visit www.guidelinecentral.com to access the pocket card.
The statement summarizes the opinion of the Task Force members based on an extensive literature review and their own experience in treating patients. All health care professionals involved in the care of patients with AF will benefit from this publication, particularly those with patients who are undergoing, or are being considered for, catheter or surgical ablation procedures for AF.
Key points of this document are as follows:
- Catheter and surgical ablation of AF are well established and important treatment options for patients with AF in whom a rhythm control strategy is chosen.
- A decision to perform catheter or surgical ablation of AF should be made after a careful consideration of the efficacy, risks, and alternatives to undergoing the ablation procedure. Patient preferences and values are important consideration. This document provides indications for both catheter and surgical AF ablation.
- The primary indication for performance of AF ablation is the presence of symptoms associated with AF. AF ablation is generally considered after at least one antiarrhythmic medication has been tried and proven to be ineffective or poorly tolerated.
- A desire to stop anticoagulation is not an appropriate indication for AF ablation. For most patients with AF who have a high stroke risk profile, anticoagulation should be continued following their ablation procedure.
- Catheter ablation of AF is associated with a risk of complications, including development of a stroke or transient ischemic attack. Careful attention to anticoagulation prior to, during, and following the ablation procedure minimizes these risks.
- Multiple tools and strategies are available to perform both catheter and surgical ablation of AF. This document provides a detailed review of each of the available options, and the recommendations are made.