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Atrial fibrillation catheter ablation: an updated review of current guidelines and expert consensus documents

Katheterablation von Vorhofflimmern: eine aktualisierte Übersicht zu Leitlinien und expertenbasierten Konsensuspapieren

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Abstract

Although atrial fibrillation (AF) is the most common cardiac arrhythmia, its management remains complex and depends on several variables. Over the past decade, catheter ablation has been widely used as an effective method for rhythm control in AF patients. Therefore, AF ablation has been the focus of many studies in recent years. Given the complexity of AF management and catheter ablation, several guidelines have been developed to regulate and direct management of AF patients. The European Society of Cardiology (ESC), together with the European Heart Rhythm Association (EHRA) and the European Association of Cardiothoracic Surgeons (EACTS), has been regulating the European guidelines, while the American Heart Association (AHA), along with the American College of Cardiology (ACC) and the Heart Rhythm Society (HRS), is publishing the US guidelines. Additionally, HRS, EHRA, and the Society of Thoracic Surgeons, along with representatives from heart rhythm societies from different parts of the world, have developed an “expert consensus statement on catheter and surgical ablation of AF.” This article reviews and compares the most recent guidelines and consensus document on AF catheter ablation.

Zusammenfassung

Obwohl Vorhofflimmern (VHF) die häufigste Herzrhythmusstörung ist, ist die Therapie weiterhin kompliziert und von verschiedenen Variablen abhängig. In den letzten zehn Jahren hat die Katheterablation als wirksames Verfahren zur Rhythmuskontrolle bei Patienten mit VHF breite Anwendung gefunden. Entsprechend war die VHF-Ablation in den vergangenen Jahren das Thema vieler Studien. Angesichts der Komplexität der VHF-Therapie und Katheterablation wurden mehrere Leitlinien entwickelt, um das Management von Patienten mit VHF zu regeln. Die European Society of Cardiology (ESC) hat in Zusammenarbeit mit der European Heart Rhythm Association (EHRA) und der European Association of Cardiothoracic Surgeons (EACTS) die europäischen Leitlinien erstellt. Die US-amerikanischen Leitlinien publiziert die American Heart Association (AHA) gemeinsam mit dem American College of Cardiology (ACC) und der Heart Rhythm Society (HRS). Des Weiteren haben die HRS, EHRA und Society of Thoracic Surgeons zusammen mit Vertretern von Gesellschaften für Herzrhythmusstörungen aus verschiedenen Teilen der Welt ein expertenbasiertes Konsensuspapier zur Katheter- und chirurgischen Ablation von VHF erarbeitet („expert consensus statement on catheter and surgical ablation of AF“). Im vorliegenden Beitrag werden die neuesten Leitlinien und das aktuelle Konsensuspapier zur Katheterablation von VHF zusammengefasst und verglichen.

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References

  1. Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Nielsen JC, Curtis AB, Davies DW, Day JD, d’Avila A, de Groot N, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T (2017) 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: executive summary. J Arrhythm 33:369–409

    Article  Google Scholar 

  2. January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC Jr., Conti JB, Ellinor PT, Ezekowitz MD, Field ME, Murray KT, Sacco RL, Stevenson WG, Tchou PJ, Tracy CM, Yancy CW, Members AATF (2014) 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation 130:2071–2104

    Article  Google Scholar 

  3. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, Castella M, Diener HC, Heidbuchel H, Hendriks J, Hindricks G, Manolis AS, Oldgren J, Popescu BA, Schotten U, Van Putte B, Vardas P, Group ESCSD (2016) 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 37:2893–2962

    Article  Google Scholar 

  4. Cosedis Nielsen J, Johannessen A, Raatikainen P, Hindricks G, Walfridsson H, Kongstad O, Pehrson S, Englund A, Hartikainen J, Mortensen LS, Hansen PS (2012) Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation. N Engl J Med 367:1587–1595

    Article  Google Scholar 

  5. Morillo CA, Verma A, Connolly SJ, Kuck KH, Nair GM, Champagne J, Sterns LD, Beresh H, Healey JS, Natale A, Investigators R (2014) Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of paroxysmal atrial fibrillation (RAAFT-2): a randomized trial. JAMA 311:692–700

    Article  CAS  Google Scholar 

  6. Wazni OM, Marrouche NF, Martin DO, Verma A, Bhargava M, Saliba W, Bash D, Schweikert R, Brachmann J, Gunther J, Gutleben K, Pisano E, Potenza D, Fanelli R, Raviele A, Themistoclakis S, Rossillo A, Bonso A, Natale A (2005) Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of symptomatic atrial fibrillation: a randomized trial. JAMA 293:2634–2640

    Article  CAS  Google Scholar 

  7. Chen YW, Bai R, Lin T, Salim M, Sang CH, Long DY, Yu RH, Tang RB, Guo XY, Yan XL, Nie JG, Du X, Dong JZ, Ma CS (2014) Pacing or ablation: which is better for paroxysmal atrial fibrillation-related tachycardia-bradycardia syndrome? Pacing Clin Electrophysiol 37:403–411

    Article  Google Scholar 

  8. Hocini M, Sanders P, Deisenhofer I, Jais P, Hsu LF, Scavee C, Weerasoriya R, Raybaud F, Macle L, Shah DC, Garrigue S, Le Metayer P, Clementy J, Haissaguerre M (2003) Reverse remodeling of sinus node function after catheter ablation of atrial fibrillation in patients with prolonged sinus pauses. Circulation 108:1172–1175

    Article  Google Scholar 

  9. Inada K, Yamane T, Tokutake K, Yokoyama K, Mishima T, Hioki M, Narui R, Ito K, Tanigawa S, Yamashita S, Tokuda M, Matsuo S, Shibayama K, Miyanaga S, Date T, Sugimoto K, Yoshimura M (2014) The role of successful catheter ablation in patients with paroxysmal atrial fibrillation and prolonged sinus pauses: outcome during a 5-year follow-up. Europace 16:208–213

    Article  Google Scholar 

  10. Furlanello F, Lupo P, Pittalis M, Foresti S, Vitali-Serdoz L, Francia P, De Ambroggi G, Ferrero P, Nardi S, Inama G, De Ambroggi L, Cappato R (2008) Radiofrequency catheter ablation of atrial fibrillation in athletes referred for disabling symptoms preventing usual training schedule and sport competition. J Cardiovasc Electrophysiol 19:457–462

    Article  Google Scholar 

  11. Koopman P, Nuyens D, Garweg C, La Gerche A, De Buck S, Van Casteren L, Alzand B, Willems R, Heidbuchel H (2011) Efficacy of radiofrequency catheter ablation in athletes with atrial fibrillation. Europace 13:1386–1393

    Article  Google Scholar 

  12. Pathak RK, Elliott A, Middeldorp ME, Meredith M, Mehta AB, Mahajan R, Hendriks JM, Twomey D, Kalman JM, Abhayaratna WP, Lau DH, Sanders P (2015) Impact of CARDIOrespiratory FITness on arrhythmia recurrence in obese individuals with atrial fibrillation: the CARDIO-FIT study. J Am Coll Cardiol 66:985–996

    Article  Google Scholar 

  13. Di Biase L, Mohanty P, Mohanty S, Santangeli P, Trivedi C, Lakkireddy D, Reddy M, Jais P, Themistoclakis S, Dello Russo A, Casella M, Pelargonio G, Narducci ML, Schweikert R, Neuzil P, Sanchez J, Horton R, Beheiry S, Hongo R, Hao S, Rossillo A, Forleo G, Tondo C, Burkhardt JD, Haissaguerre M, Natale A (2016) Ablation versus amiodarone for treatment of persistent atrial fibrillation in patients with congestive heart failure and an implanted device: results from the AATAC multicenter randomized trial. Circulation 133:1637–1644

    Article  Google Scholar 

  14. Marrouche NF, Kheirkhahan M, Brachmann J (2018) Catheter ablation for atrial fibrillation with heart failure. N Engl J Med 379:492

    PubMed  Google Scholar 

  15. Briceno DF, Markman TM, Lupercio F, Romero J, Liang JJ, Villablanca PA, Birati EY, Garcia FC, Di Biase L, Natale A, Marchlinski FE, Santangeli P (2018) Catheter ablation versus conventional treatment of atrial fibrillation in patients with heart failure with reduced ejection fraction: a systematic review and meta-analysis of randomized controlled trials. J Interv Cardiac Electrophysiol 53:19–29

    Article  Google Scholar 

  16. January CT, Wann LS, Calkins H, Chen LY, Cigarroa JE, Cleveland JC Jr., Ellinor PT, Ezekowitz MD, Field ME, Furie KL, Heidenreich PA, Murray KT, Shea JB, Tracy CM, Yancy CW (2019) 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in Collaboration With the Society of Thoracic Surgeons. Circulation 140:e125–e151

    Article  Google Scholar 

  17. Boriani G, Laroche C, Diemberger I, Fantecchi E, Popescu MI, Rasmussen LH, Sinagra G, Petrescu L, Tavazzi L, Maggioni AP, Lip GY (2015) Asymptomatic atrial fibrillation: clinical correlates, management, and outcomes in the EORP-AF Pilot General Registry. Am J Med 128:509–518e2

    Article  Google Scholar 

  18. Forleo GB, De Martino G, Mantica M, Carreras G, Parisi Q, Zingarini G, Panigada S, Romano E, Dello Russo A, Di Biase L, Natale A, Tondo C (2013) Clinical impact of catheter ablation in patients with asymptomatic atrial fibrillation: the IRON-AF (Italian registry on NavX atrial fibrillation ablation procedures) study. Int J Cardiol 168:3968–3970

    Article  Google Scholar 

  19. Mohanty S, Santangeli P, Mohanty P, Di Biase L, Holcomb S, Trivedi C, Bai R, Burkhardt D, Hongo R, Hao S, Beheiry S, Santoro F, Forleo G, Gallinghouse JG, Horton R, Sanchez JE, Bailey S, Hranitzky PM, Zagrodzky J, Natale A (2014) Catheter ablation of asymptomatic longstanding persistent atrial fibrillation: impact on quality of life, exercise performance, arrhythmia perception, and arrhythmia-free survival. J Cardiovasc Electrophysiol 25:1057–1064

    Article  Google Scholar 

  20. Wu L, Lu Y, Zheng L, Qiao YU, Chen G, Ding L, Hou B, Sun W, Liew R, Zhang S, Yao Y (2016) Comparison of radiofrequency catheter ablation between asymptomatic and symptomatic persistent atrial fibrillation: a propensity score matched analysis. J Cardiovasc Electrophysiol 27:531–535

    Article  Google Scholar 

  21. Haissaguerre M, Jais P, Shah DC, Takahashi A, Hocini M, Quiniou G, Garrigue S, Le Mouroux A, Le Metayer P, Clementy J (1998) Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 339:659–666

    Article  CAS  Google Scholar 

  22. Kuck KH, Hoffmann BA, Ernst S, Wegscheider K, Treszl A, Metzner A, Eckardt L, Lewalter T, Breithardt G, Willems S, Gap AFAI (2016) Impact of complete versus incomplete circumferential lines around the pulmonary veins during catheter ablation of paroxysmal atrial fibrillation: results from the gap-atrial fibrillation-German atrial fibrillation competence network 1 trial. Circ Arrhythm Electrophysiol 9:e3337

    Article  Google Scholar 

  23. Verma A, Jiang CY, Betts TR, Chen J, Deisenhofer I, Mantovan R, Macle L, Morillo CA, Haverkamp W, Weerasooriya R, Albenque JP, Nardi S, Menardi E, Novak P, Sanders P and Investigators SAI. (2015) Approaches to catheter ablation for persistent atrial fibrillation. N Engl J Med 372:1812–1822

    Article  Google Scholar 

  24. Kuck KH, Brugada J, Furnkranz A, Metzner A, Ouyang F, Chun KR, Elvan A, Arentz T, Bestehorn K, Pocock SJ, Albenque JP, Tondo C, Fire and Investigators ICE. (2016) Cryoballoon or Radiofrequency Ablation for Paroxysmal Atrial Fibrillation. N Engl J Med 374:2235–2245

    Article  Google Scholar 

  25. Verma A, Kilicaslan F, Pisano E, Marrouche NF, Fanelli R, Brachmann J, Geunther J, Potenza D, Martin DO, Cummings J, Burkhardt JD, Saliba W, Schweikert RA, Natale A (2005) Response of atrial fibrillation to pulmonary vein antrum isolation is directly related to resumption and delay of pulmonary vein conduction. Circulation 112:627–635

    Article  Google Scholar 

  26. Ouyang F, Antz M, Ernst S, Hachiya H, Mavrakis H, Deger FT, Schaumann A, Chun J, Falk P, Hennig D, Liu X, Bansch D, Kuck KH (2005) Recovered pulmonary vein conduction as a dominant factor for recurrent atrial tachyarrhythmias after complete circular isolation of the pulmonary veins: lessons from double Lasso technique. Circulation 111:127–135

    Article  Google Scholar 

  27. Calkins H, Willems S, Gerstenfeld EP, Verma A, Schilling R, Hohnloser SH, Okumura K, Serota H, Nordaby M, Guiver K, Biss B, Brouwer MA, Grimaldi M, Investigators R‑C (2017) Uninterrupted Dabigatran versus warfarin for ablation in atrial fibrillation. N Engl J Med 376:1627–1636

    Article  CAS  Google Scholar 

  28. Di Biase L, Burkhardt JD, Santangeli P, Mohanty P, Sanchez JE, Horton R, Gallinghouse GJ, Themistoclakis S, Rossillo A, Lakkireddy D, Reddy M, Hao S, Hongo R, Beheiry S, Zagrodzky J, Rong B, Mohanty S, Elayi CS, Forleo G, Pelargonio G, Narducci ML, Dello Russo A, Casella M, Fassini G, Tondo C, Schweikert RA, Natale A (2014) Periprocedural stroke and bleeding complications in patients undergoing catheter ablation of atrial fibrillation with different anticoagulation management: results from the Role of Coumadin in Preventing Thromboembolism in Atrial Fibrillation (AF) Patients Undergoing Catheter Ablation (COMPARE) randomized trial. Circulation 129:2638–2644

    Article  Google Scholar 

  29. Cappato R, Marchlinski FE, Hohnloser SH, Naccarelli GV, Xiang J, Wilber DJ, Ma CS, Hess S, Wells DS, Juang G, Vijgen J, Hugl BJ, Balasubramaniam R, De Chillou C, Davies DW, Fields LE, Natale A, Investigators V‑A (2015) Uninterrupted rivaroxaban vs. uninterrupted vitamin K antagonists for catheter ablation in non-valvular atrial fibrillation. Eur Heart J 36:1805–1811

    Article  CAS  Google Scholar 

  30. Kirchhof P, Haeusler KG, Blank B, De Bono J, Callans D, Elvan A, Fetsch T, Van Gelder IC, Gentlesk P, Grimaldi M, Hansen J, Hindricks G, Al-Khalidi HR, Massaro T, Mont L, Nielsen JC, Nolker G, Piccini JP, De Potter T, Scherr D, Schotten U, Themistoclakis S, Todd D, Vijgen J, Di Biase L (2018) Apixaban in patients at risk of stroke undergoing atrial fibrillation ablation. Eur Heart J 39:2942–2955

    Article  CAS  Google Scholar 

  31. Hohnloser SH, Camm J, Cappato R, Diener HC, Heidbuchel H, Mont L, Morillo CA, Abozguia K, Grimaldi M, Rauer H, Reimitz PE, Smolnik R, Monninghoff C, Kautzner J (2019) Uninterrupted edoxaban vs. vitamin K antagonists for ablation of atrial fibrillation: the ELIMINATE-AF trial. Eur Heart J. https://doi.org/10.1093/eurheartj/ehz190

    Article  PubMed  PubMed Central  Google Scholar 

  32. Steffel J, Verhamme P, Potpara TS, Albaladejo P, Antz M, Desteghe L, Haeusler KG, Oldgren J, Reinecke H, Roldan-Schilling V, Rowell N, Sinnaeve P, Collins R, Camm AJ, Heidbuchel H and Group ESCSD (2018) The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Eur Heart J 39:1330–1393

    Article  CAS  Google Scholar 

  33. Deshmukh A, Patel NJ, Pant S, Shah N, Chothani A, Mehta K, Grover P, Singh V, Vallurupalli S, Savani GT, Badheka A, Tuliani T, Dabhadkar K, Dibu G, Reddy YM, Sewani A, Kowalski M, Mitrani R, Paydak H, Viles-Gonzalez JF (2013) In-hospital complications associated with catheter ablation of atrial fibrillation in the United States between 2000 and 2010: analysis of 93 801 procedures. Circulation 128:2104–2112

    Article  Google Scholar 

  34. Vasamreddy CR, Lickfett L, Jayam VK, Nasir K, Bradley DJ, Eldadah Z, Dickfeld T, Berger R, Calkins H (2004) Predictors of recurrence following catheter ablation of atrial fibrillation using an irrigated-tip ablation catheter. J Cardiovasc Electrophysiol 15:692–697

    Article  Google Scholar 

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  1. Division of Cardiology, The Johns Hopkins Hospital, 1800 Orleans Street, Sheikh Zayed Tower 7125R, 21287, Baltimore, MD, USA

    Mohammadali Habibi MD & Hugh Calkins MD

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Correspondence to Hugh Calkins MD.

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M. Habibi and H. Calkins declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.

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Habibi, M., Calkins, H. Atrial fibrillation catheter ablation: an updated review of current guidelines and expert consensus documents. Herzschr Elektrophys 30, 371–376 (2019). https://doi.org/10.1007/s00399-019-00651-0

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