Feature | Atrial Fibrillation | May 15, 2017

Expert Consensus Released on Catheter, Surgical Ablation of Atrial Fibrillation

Five international societies partnered to provide state-of-the-art review and recommendations for the care of patients with AF

Guidelines updated for atrial fibrillation ablation at HRS 2017. Boston Scientific's Rhythmia mapping system

May 15, 2017 – The Heart Rhythm Society (HRS) in joint partnership with several other electrophysiology societies issued an international consensus statement that provides a state-of-the-art review of the indications, techniques and outcomes of catheter and surgical ablation of atrial fibrillation (AF). The HRS partnered with the European Heart Rhythm Association (EHRA), European Cardiac Arrhythmia Society (ECAS), Asia Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLAECE) to develop the “2017 HRS/EHRA/ECAS/APHRS/SOLAECE Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation.” 

The document was first issued in 2007 and revised in 2012. It represents a state-of-the art review of the field of catheter and surgical ablation of AF. This document is a complete and comprehensive revision of the 2012 statement and was presented today at Heart Rhythm 2017, the Heart Rhythm Society’s 38th Annual Scientific Sessions.

AF is a common arrhythmia condition that affects an estimated 33 million people worldwide and has been known to increase a person’s risk of stroke and death.[1] Catheter and surgical ablation of AF have evolved from investigational procedures to effective treatment options for patients. These procedures are now performed in most major hospitals throughout the world.

“The rate of advancement in the tools, techniques, and outcomes of AF ablation continues to increase at a rapid pace. Our writing group worked together to revise the current recommendations to address the medical advancements that have really evolved over the last five years,” said Hugh Calkins, M.D., FHRS, CCDS, past president of HRS, Nicholas J. Fortuin M.D. Professor of Cardiology, and director of the electrophysiology laboratory and arrhythmia service at the Johns Hopkins Hospital. “It is our hope that this document can help improve patient care by providing a foundation for everyone involved in the care of AF patients including clinicians who perform catheter or surgical ablations.”

Watch the VIDEO "Current State of Atrial Fibrillation Technologies," an interview with Dr. Calkins at HRS 2017

For the first time, the writing group, comprised of 60 experts from international organizations, addresses the important issue of catheter ablation of AF in select asymptomatic patients. The group also addresses the important issues of AF ablation as first-line therapy, the role of AF ablation in patients with heart failure, anticoagulation recommendations for patients undergoing ablation therapy, and the role of AF ablation in subgroups of patients not well represented in clinical trials. Recommendations pertinent to the design of clinical trials in the field of AF ablation and the reporting of outcomes, including relevant definitions, are also covered. 

Specifically, the document includes detailed findings within the following topic sections:
• Definitions, Mechanisms, and Rationale for AF Ablation
• Modifiable Risk Factors for AF and Impact on Ablation
• Indications
• Strategies, Techniques, Endpoints
• Technology and Tools
• Technical Aspects of Ablation to Maximize Safety and Anticoagulation
• Follow-up Considerations
• Outcomes and Efficacy
• Complications
• Training Requirements
• Surgical and Hybrid AF Ablation
• Clinical Trial Design

The expert consensus statement was written in collaboration with 11 organizations including the Heart Rhythm Society (HRS), European Heart Rhythm Association (EHRA), European Cardiac Arrhythmia Society (ECAS), Asia Pacific Heart Rhythm Society (APHRS), Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLAECE), Society of Thoracic Surgeons (STS), American College of Cardiology (ACC), American Heart Association (AHA), Canadian Heart Rhythm Society (CHRS), Japanese Heart Rhythm Society (JHRS) and Sociedade Brasileira de Arritmias Cardíacas (SOBRAC).

The final decision regarding care of a patient should be made by health care providers and their patient in light of all the circumstances presented by the patient. It is recognized that this field continues to evolve rapidly, and ongoing research will be needed.

The document was also published in an upcoming issue HeartRhythm, the official journal of the Heart Rhythm Society. 

For more information: www.hrssessions.org

Reference:
1. Chugh SS, Havmoeller R, Narayanan K, Singh D, Rienstra M, Benjamin EJ, et al. “Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study.” Circulation 2014;129:837–847.

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