TY - JOUR
T1 - Ablation of Atrial Fibrillation
T2 - Patient Selection, Periprocedural Anticoagulation, Techniques, and Preventive Measures after Ablation
AU - Link, Mark S.
AU - Haïssaguerre, Michel
AU - Natale, Andrea
N1 - Funding Information:
DISCLOSURES Dr Natale has received consultant fees or honoraria from Biosense Webster, Boston Scientific, Medtronic, St. Jude Medical, Jansen, Biotronik, and LifeWatch. Dr Ha?ssaguerre has received lecture honorarium from Biosense-Webster and research grants from Medtronic and Biosense-Webster. His work is supported by a grant from Agence Nationale de la Recherche under grant arrangements IHU LIRYC ANR-10-IAHU- 04. Dr Link reports no conflicts.
Publisher Copyright:
© 2016 American Heart Association, Inc.
PY - 2016/7/26
Y1 - 2016/7/26
N2 - Atrial fibrillation (AF) is the most common arrhythmia encountered by cardiologists and is a major cause of morbidity and mortality. Risk factors for AF include age, male sex, genetic predisposition, hypertension, diabetes mellitus, sleep apnea, obesity, excessive alcohol, smoking, hyperthyroidism, pulmonary disease, air pollution, heart failure, and possibly excessive exercise. The management of AF involves decisions about rate versus rhythm control. Asymptomatic patients are generally managed with rate control and anticoagulation. Symptomatic patients will desire rhythm control. Rhythm control options are either antiarrhythmic agents or ablation, with each having its own risks and benefits. Ablation of AF has evolved from a rare and complex procedure to a common electrophysiological technique. Selection of patients to undergo ablation is an important aspect of AF care. Patients with the highest success rates of ablation are those with normal structural hearts and paroxysmal AF, although those with congestive heart failure have the greatest potential benefit of the procedure. Although pulmonary vein isolation of any means/energy source is the approach generally agreed on for those with paroxysmal AF, optimal techniques for the ablation of nonparoxysmal AF are not yet clear. Anticoagulation reduces thromboembolic complications; the newer anticoagulants have eased management for both the patient and the cardiologist. Aggressive management of modifiable risk factors (hypertension, diabetes mellitus, sleep apnea, obesity, excessive alcohol, smoking, hyperthyroidism, pulmonary disease, air pollution, and possibly excessive exercise) after ablation reduces the odds of recurrent AF and is an important element of care.
AB - Atrial fibrillation (AF) is the most common arrhythmia encountered by cardiologists and is a major cause of morbidity and mortality. Risk factors for AF include age, male sex, genetic predisposition, hypertension, diabetes mellitus, sleep apnea, obesity, excessive alcohol, smoking, hyperthyroidism, pulmonary disease, air pollution, heart failure, and possibly excessive exercise. The management of AF involves decisions about rate versus rhythm control. Asymptomatic patients are generally managed with rate control and anticoagulation. Symptomatic patients will desire rhythm control. Rhythm control options are either antiarrhythmic agents or ablation, with each having its own risks and benefits. Ablation of AF has evolved from a rare and complex procedure to a common electrophysiological technique. Selection of patients to undergo ablation is an important aspect of AF care. Patients with the highest success rates of ablation are those with normal structural hearts and paroxysmal AF, although those with congestive heart failure have the greatest potential benefit of the procedure. Although pulmonary vein isolation of any means/energy source is the approach generally agreed on for those with paroxysmal AF, optimal techniques for the ablation of nonparoxysmal AF are not yet clear. Anticoagulation reduces thromboembolic complications; the newer anticoagulants have eased management for both the patient and the cardiologist. Aggressive management of modifiable risk factors (hypertension, diabetes mellitus, sleep apnea, obesity, excessive alcohol, smoking, hyperthyroidism, pulmonary disease, air pollution, and possibly excessive exercise) after ablation reduces the odds of recurrent AF and is an important element of care.
KW - ablation techniques
KW - anti-arrhythmia agents
KW - anticoagulants
KW - atrial fibrillation
KW - pulsed radiofrequency treatment
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U2 - 10.1161/CIRCULATIONAHA.116.021727
DO - 10.1161/CIRCULATIONAHA.116.021727
M3 - Article
C2 - 27462054
AN - SCOPUS:84980000109
SN - 0009-7322
VL - 134
SP - 339
EP - 352
JO - Circulation
JF - Circulation
IS - 4
ER -