104
Management
8.3.4. Upstream Therapy
8.4. AF Catheter Ablation
COR LOE
Recommendations
1 A 1. In patients with symptomatic AF in whom AADs have
been ineffective, contraindicated, not tolerated or not
preferred, and continued rhythm control is desired,
catheter ablation is useful to improve symptoms.
1 A 2. In selected patients (generally younger with few
comorbidities) with symptomatic paroxysmal AF in
whom rhythm control is desired, catheter ablation is
useful as first-line therapy to improve symptoms and
reduce progression to persistent AF.
1 A 3. In patients with symptomatic or clinically significant
AFL, catheter ablation is useful for improving symptoms.
2a B-NR 4. In patients who are undergoing ablation for AF, ablation
of additional clinically significant supraventricular
arrhythmias can be useful to reduce the likelihood of
future arrhythmia.
2a B-R 5. In patients (other than younger with few comorbidities)
with symptomatic paroxysmal or persistent AF who are
being managed with a rhythm-control strateg y, catheter
ablation as first-line therapy can be useful to improve
symptoms.
Cost Value
Statement:
Intermediate
B-R 6. Catheter ablation for symptomatic AF provides
intermediate economic value compared with AAD
therapy.
2b B-NR 7. In selected* patients with asymptomatic or minimally
symptomatic AF, catheter ablation may be useful
for reducing progression of AF and its associated
complications.
* Younger patients with few comorbidities and a moderate to high burden of AF or persistent
AF and AFL.
