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Left atrial ablation and pace and ablate therapy in atrial fibrillation (AF)

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

NICE atrial fibrillation guidance states (1):

  • pace and ablate strategy
    • consider pacing and atrioventricular node ablation for people with permanent atrial fibrillation with symptoms or left ventricular dysfunction thought to be caused by high ventricular rates

    • when considering pacing and atrioventricular node ablation, reassess symptoms and the consequent need for ablation after pacing has been carried out and drug treatment further optimised

    • consider left atrial catheter ablation before pacing and atrioventricular node ablation for people with paroxysmal atrial fibrillation or heart failure caused by non-permanent (paroxysmal or persistent) atrial fibrillation

  • left atrial ablation

    • if drug treatment is unsuccessful, unsuitable or not tolerated in people with symptomatic paroxysmal or persistent atrial fibrillation:
      • consider radiofrequency point-by-point ablation or
      • if radiofrequency point-by-point ablation is assessed as being unsuitable, consider cryoballoon ablation or laser balloon ablation

    • consider left atrial surgical ablation at the same time as other cardiothoracic surgery for people with symptomatic atrial fibrillation

  • preventing recurrence after ablation
    • consider antiarrhythmic drug treatment for 3 months after left atrial ablation to prevent recurrence of atrial fibrillation, taking into account the person's preferences, and the risks and potential benefits
    • reassess the need for antiarrhythmic drug treatment at 3 months after left atrial ablation

Reference:

 


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