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Key Points
➤ Catheter and surgical ablation of atrial fibrillation (AF) are well
established and important treatment options for patients with atrial
fibrillation 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 atrial fibrillation. 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 recommendations are made.
➤ There is considerable effort focused on developing new tools
and techniques for AF ablation. This document contained
recommendations concerning the performance of future clinical trials.
e grading system for indication level of class of evidence was adapted based on that used by the
ACC and the AHA. (A. K. Jacobs, Anderson, & Halperin, 2014) (Anderson, 2015).
Colors in tables correspond to Class of Recommendation Table on pages 32-33.
