Catheter AF Ablation Growing in Popularity and Complexity

Catheter ablation is fast becoming one of the safest and most effective treatments for atrial fibrillation (AF) as new technologies become increasingly available to treat a wide spectrum of the roughly 40 million people worldwide with the condition.

In a recently published policy statement, the Heart Rhythm Society pointed out that physicians who perform AF ablation must formally maintain their skills in electrophysiology-based testing and mapping, as well as in methods of advanced ablation.

In the United States, physicians complete fellowship training in advanced electrophysiology to attain board-eligible or board-certified status in clinical cardiac electrophysiology. This training enables clinicians to “interpret evolving evidence while adopting novel techniques to deliver state-of-the-art comprehensive arrhythmia care aimed at optimal long-term outcomes for patients,” according to the society.

Despite the introduction of tools that facilitate ablation based on anatomy, pulmonary vein electrical isolation is the cornerstone of AF ablation and is essential to the success of the procedure, according to the statement. Because the lack of complete and durable pulmonary vein electrical isolation is an important cause of recurrent AF after ablation, physicians must perform electrophysiology testing to assess the effectiveness of procedure.

Difficult Combined Procedures

The use of catheter AF ablation in combination with percutaneous left atrial appendage closure or occlusion is gaining traction among clinicians, reported the society. However, outcomes of the combined procedure remain uncertain. As a result, physicians who perform these two complex procedures need a heightened attention to detail to achieve optimal quality and outcomes, warned the society.

With the combined procedure, AF ablation should be performed using the same comprehensive electrophysiology evaluation and endpoints as standalone AF ablation.

The society is committed to ensuring consistent and quality care for AF management, said Kenneth A. Ellenbogen, MD, president of the group. “EP [electrophysiology] endpoints remain essential to the success of AF ablation. This statement emphasizes and reaffirms the foundational principles of AF ablation aimed at optimal long-term outcomes for patients suffering from atrial fibrillation,” he said.