International experts update best practices for patient selection, procedural techniques, and post-ablation care.

Summary: International experts have published updated guidelines for treating atrial fibrillation with catheter and surgical ablation. The new consensus statement outlines best practices for patient selection, procedural techniques, and post-ablation care, emphasizing the safety and effectiveness of modern innovations like pulsed field ablation and intracardiac echocardiography. Patients are advised to maintain a healthy lifestyle and adhere to specific pre- and post-procedural medical instructions. The guidelines aim to enhance treatment outcomes and manage symptoms for atrial fibrillation patients, including those with heart failure.

Key Takeaways: 

  • The new guidelines provide comprehensive standards for patient selection, procedural techniques, and post-ablation care to ensure safe and effective treatment of atrial fibrillation.
  • Advances such as pulsed field ablation and intracardiac echocardiography have improved the safety and efficacy of catheter ablation procedures.
  • Emphasis is placed on maintaining a healthy lifestyle, following specific pre- and post-procedural instructions, and continued use of anticoagulants and antiarrhythmic drugs to reduce complications and recurrences.

International experts have published a new consensus statement on standards for treating atrial fibrillation with catheter or surgical ablation. 

The statement was published in EP Europace, a journal of the European Society of Cardiology (ESC), and presented at EHRA 2024, a scientific congress of the ESC.

“Ablation is the most effective way to prevent recurrences of atrial fibrillation and delay progression to more advanced forms. Pioneering techniques have emerged since the previous consensus in 2017, requiring new advice on who should receive this procedure and how to perform it in the safest and most effective manner,” says lead author Stylianos Tzeis, MD, in a release. 

Catheter ablation of atrial fibrillation is an important treatment option for maintaining a normal heart rhythm and reducing arrhythmia-related symptoms. It is typically a one- to two-hour, minimally invasive procedure in which a catheter is inserted into a blood vessel in the groin and advanced into the heart, with patients going home the same or next day.

Best Practice Standards

The document sets out best practice standards and practical advice on which patients should receive ablation, how to perform the procedure, and how to manage patients before, during, and afterward. A healthy lifestyle is advised to reduce the risk of developing atrial fibrillation and to lower the number of recurrences.

Catheter ablation is beneficial as first-line treatment in patients with symptoms and recurrent atrial fibrillation. It is also beneficial in symptomatic patients with recurrent paroxysmal or persistent atrial fibrillation who are resistant or intolerant to at least one antiarrhythmic drug. 

Patients with atrial fibrillation and heart failure, a condition in which the heart muscle cannot pump enough blood to meet the body’s needs, benefit from ablation to alleviate symptoms, increase the heart’s strength, and improve their prognosis.

Pre- and Post-Procedure Care

Before the procedure, patients should have an electrocardiogram (ECG) and echocardiogram to check the heart’s rhythm and function. Some patients need computed tomography or transoesophageal echocardiography to exclude the presence of a blood clot in the heart. Blood thinners should not be interrupted before catheter ablation and patients should receive specific instructions from their healthcare provider on continuing their medication.

After the procedure, all patients should receive anticoagulation for at least two months. Prolonged anticoagulation may be required depending on the risk of blood clots. Antiarrhythmic drugs are advised for some patients to prevent arrhythmia recurrences early after the procedure. Complications following catheter ablation are uncommon but can include stroke, pericardial tamponade (fluid accumulation around the heart), transient ischaemic attack, and vascular complications at the access site in the groin. The risk of death is extremely low (0.05-0.1%).

Technological Innovations

“Technological innovations have made catheter ablation safer and more effective than ever before. For example, we now have pulsed field ablation which uses high energy electrical pulses to treat atrial fibrillation without damaging the nerves or oesophagus. We can also use intracardiac echocardiography to guide and facilitate the procedure with real-time visualisation of the cardiac structures being treated,” says Tzeis in a release. 

The international consensus statement was developed by the European Heart Rhythm Association, a branch of the ESC; the Heart Rhythm Society; the Asia Pacific Heart Rhythm Society; and the Latin American Heart Rhythm Society. It is also published in Heart Rhythm, Journal of Arrhythmia, and Journal of Interventional Cardiac Electrophysiology.

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