Ablation-atrial fibrillation

(Heart Rhythm 2017;14:e445; JACC 2020;75:1689)

參考➡️ 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation

• Controlling triggers in pulm veins effective when little atrial fibrosis; as AF persists, substrate more complex
• Pulm vein isolation (radiofreq or cryo; NEJM 2016;374:2235): ~70% success; superior to AAD (JAMA 2014;311:692; NEJM 2021;384:305 & 316) & ↑ QoL (JAMA 2019;321:1059)

參考➡️ Effect of catheter ablation vs antiarrhythmic medication on quality of life in patients with atrial fibrillation: the CAPTAF randomized clinical trial 參考➡️ Cryoablation or drug therapy for initial treatment of atrial fibrillation 參考➡️ Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of paroxysmal atrial fibrillation (RAAFT-2): a randomized trial

• If NYHA II–IV + EF <35%, ablation ↓ D/HF hosp vs. rate/rhythm meds (NEJM 2018;378:417)
• AV node ablation + PPM if other Rx inadequate (NEJM 2001;344:1043 & 2002;346:2062)