BOSTON — Catheter ablation for atrial fibrillation has been set as the sole second-line therapy for all patients in the treatment guidelines scheduled to be released later this year by the American College of Cardiology, the American Heart Association, and the European Society of Cardiology.
By the new guidelines, patients have to fail only one drug before they become eligible for catheter ablation. This recommendation applies to all patients with atrial fibrillation, including those with concurrent heart failure, coronary artery disease, or hypertension, said Dr. Eric Prystowsky, a member of the guideline-writing committee, at an international symposium on atrial fibrillation sponsored by Massachusetts General Hospital.
There isn't enough evidence of safety and efficacy in many laboratories to label ablation as first-line treatment, he added.
“The problem with ablation of atrial fibrillation is that it is so operator dependent,” Dr. Prystowsky said. The best outcomes are in high-volume, highly experienced laboratories. Labs with less experience produce fewer cures and complication-free results, he said. The drugs set as potential first-line treatments in the guidelines are the standard agents, including sotalol, flecainide, and propafenone.
The guidelines will allow certain patients to skip a trial with an antiarrhythmic drug and proceed directly to ablation, including patients for whom the only possible drug treatment is amiodarone, patients who refuse to take an antiarrhythmic drug, and patients who cannot be treated with warfarin.
Ablation may also be a first option for patients treated in experienced laboratories that have a record of high success rates, said Dr. Prystowsky, director of the clinical electrophysiology laboratory at St. Vincent Hospital in Indianapolis.
By the new guidelines, patients have to fail only one drug before they are eligible for catheter ablation. DR. PRYSTOWSKY