8
Treatment
Table 3. Atrial Fibrillation Ablation: Strategies, Techniques,
and Endpoints
Recommendations COR LOE
PV isolation by
catheter ablation
Electrical isolation of the PVs is
recommended during all AF ablation
procedures.
1 A
Achievement of electrical isolation
requires, at a minimum, assessment and
demonstration of entrance block into the
PV.
1 B-R
Monitoring for PV reconnection for 20
minutes following initial PV isolation is
reasonable.
2A B-R
Administration of adenosine 20 minutes
following initial PV isolation using RF
energ y with reablation if PV reconnection
may be considered.
2B B-R
Use of a pace-capture (pacing along the
ablation line) ablation strateg y may be
considered.
2B B-R
Demonstration of exit block may be
considered.
2B B-NR
Ablation
strategies to be
considered for use
in conjunction
with PV isolation
If the patient has a history of typical atrial
flutter or typical atrial flutter is induced
at the time of AF ablation, delivery of
a cavotricuspid isthmus linear lesion is
recommended.
1 B-R
If linear ablation lesions are applied,
operators should use mapping and pacing
maneuvers to assess for line completeness.
1 C-LD
If a reproducible focal trigger that initiates
AF is identified outside the PV ostia at the
time of an AF ablation procedure, ablation
of the focal trigger should be considered.
2A C-LD
When performing AF ablation with a
force-sensing RF ablation catheter, a
minimal targeted contact force of 5–10
grams is reasonable.
2A C-LD
