105
8.4.2. Techniques and Technologies for AF Catheter Ablation
COR LOE
Recommendations
1 A 1. In patients undergoing ablation for AF, pulmonary vein
isolation (PVI) is recommended as the primary lesion set for
all patients unless a different specific trigger is identified.
2b B-R 2. In patients undergoing ablation for AF, the value of other
endpoints beyond PVI such as noninducibility and ablation of
additional anatomic ablation targets (eg, posterior wall, sites,
low voltage areas, complex fractionated electrograms, rotors)
is uncertain.
8.4.3. Management of Recurrent AF After Catheter Ablation
COR LOE
Recommendations
1 B-NR 1. In patients with recurrent symptomatic AF after catheter
ablation, repeat catheter ablation or AAD therapy is useful to
improve symptoms and freedom from AF.
2a A 2. In some patients who have undergone catheter ablation of AF,
short-term AAD therapy after ablation can be useful to reduce
early recurrences of atrial arrhythmia and hospitalization.
8.4.4. Anticoagulation Therapy Before and After Catheter
Ablation
COR LOE
Recommendations
1 B-NR 1. In patients undergoing catheter ablation of AF on warfarin,
catheter ablation should be performed on uninterrupted
therapeutic anticoagulation with a goal INR of 2.0 to 3.0.
1 A 2. In patients on a DOAC undergoing catheter ablation of AF,
catheter ablation should be performed with either continuous
or minimally interrupted oral anticoagulation.
1 B-NR 3. In patients who have undergone catheter ablation of AF, oral
anticoagulation should be continued for at least 2 to 3 months
after the procedure with a longer duration determined by
underlying risk.
1 B-NR 4. In patients who have undergone catheter ablation of AF,
continuation of longer-term oral anticoagulation should be
dictated according to the patients' stroke risk (eg, CHA
2
DS
2
-
VASc score ≥2).
8.4.1. Patient Selection
