2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation

Abstract

In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society .

Micro-Costing Analysis for the Treatment of Atrial Fibrillation: An Economic Evaluation of the First Italian Experience of Same-Day Discharge Protocol for Cryoballoon Atrial Fibrillation Ablation

“…In the case of a CHA2DS2-VASC score ≥2 and AF recorded in the morning, transesophageal echocardiography (TEE) was scheduled before admission to the electrophysiology lab. The periprocedural anticoagulation strategy was uninterrupted or minimally interrupted [11]. The catheter ablation procedure was performed with the 28 mm Arctic Front Advance Pro TM cryoballoon ablation catheter (Medtronic, Medtronic, Inc., Minneapolis, MN, USA) as the first case of the day (usually two cryoballoon cases per day).…”

Pulmonary Vein Isolation with Pulsed Field Ablation and Size-Adjustable Cryo-Balloon: A Comparative Procedural Analysis of First-Time Use

“…As known, AF significantly impacts both morbidity and mortality. Depending on the CHA2DS2-VASc score, anticoagulation therapy should be initiated to prevent potential complications, such as thrombus formation in the left atrium and stroke, in patients with atrial fibrillation [ 4 , 5 , 6 ]. Depending on individual related factors rhythm or rate control is aimed for AF patients [ 4 , 5 , 6 ].…”

“…Depending on the CHA2DS2-VASc score, anticoagulation therapy should be initiated to prevent potential complications, such as thrombus formation in the left atrium and stroke, in patients with atrial fibrillation [ 4 , 5 , 6 ]. Depending on individual related factors rhythm or rate control is aimed for AF patients [ 4 , 5 , 6 ]. Although electrical cardioversion and antiarrhythmic drug therapy are available options for rhythm control, atrial fibrillation ablation is becoming an increasingly favored method [ 7 ].…”

Transesophageal echocardiography before atrial fibrillation ablation: to do or not to do?

“…While the "less invasive" approach represented by electrical cardioversion may be safely omitted when the patient is strictly following oral anticoagulation regimens, either assuming the DOACs continuously or the vitamin K antagonist for obtaining the right therapeutic range along several checks (the so-called time therapeutic range higher than 70%), ruling out TEE when TCA of AF is planned yet represents a matter of debate. Improved materials and technology evolution in high volume and experienced hospital centres allow to perform transeptal puncture by simply adopting X-ray anatomical points in real time; on the other side, the actual exclusion of periprocedural LAA thrombus is a critical caveat that has prompted several trials in suggesting ablation under no interruption or minimally interruption of the DOACs [1,2,10]. Unfortunately, periprocedural TEE with or without uninterrupted DOACs does not warrant stroke-free procedures in all cases; perhaps, the atrial cardiomyopathy that develops when AF is not treated adequately, is responsible for loss of atrial contraction and transport function [12] that can be translated in increased risk of stroke in few cases, while others might experience cognitive decline and dementia [13,14].…”

“…We therefore agree with the current perspective which could be reinforced by cardiac computed tomography, particularly with delayed contrast-enhanced image acquisition protocol, that has emerged as an alternate imaging modality to exclude intracardiac thrombus, as well as for cardiac magnetic resonance imaging. Remarkably, it should be considered that catheter-based intracardiac ultrasound can be implemented as well for transeptal puncture and for LAA thrombus exclusion, with the additional value of pulmonary veins visualization for ameliorating wall contact and ensuing transmural lesions that allow AF-free survival in majority of the studies [1,2]. Time has therefore arrived for standardization of ablation procedures; nowadays, great practice variation exists on how TCA of AF is performed, either considering the invasive approach as firs-line therapy or repeated procedures.…”