New AF ablation consensus document previewed at symposium

Boston AF Symposium

BOSTON — Physicians who care for patients with atrial fibrillation can anticipate a soon-to-be-released international consensus document on catheter and surgical ablation techniques.

The document, an update to the first AF consensus document released in 2007, will include recommendations for patient selection, procedure techniques, management and follow-up, new definitions and research trial design, among other improvements.

Hugh Calkins

“The 2012 statement provides an up-to-date review of the indications, techniques and outcomes of catheter and surgical ablation of AF,” Hugh Calkins, MD, consensus task force chair and director of the Cardiac Arrhythmia Service at The Johns Hopkins Hospital, said at the symposium.

Similar to the previous statement, the updated consensus focuses on 11 different sections, according to Calkins.

“Possibly the biggest change in this document is, for the first time, we have the addition of class and level of grades of indication for catheter and surgical ablation of AF,” he said.

The updated consensus will also contain 53 definitions, many which were requested by the FDA to guide clinical research, Calkins said. Some definitions are carried over unchanged from the 2007 document. One change was minor edits in the definitions of paroxysmal and persistent AF.

“In the new document, we made the distinction that if someone has AF less than 48 hours and a physician chooses to cardiovert them or give them a drug that terminates [the AF], it is still considered paroxysmal and not persistent AF,” he said.

Notable updates address strategies that use new anticoagulants, such as factor direct thrombin inhibitors and factor Xa inhibitors, before and after ablation, as well as the use of the CHADS_VASC and CHADS stroke risk stratification scores.

“This consensus document is an up-to-date, highly referenced review that 45 of your colleagues spent a lot of time working on,” Calkins said. “We hope this document will improve patient care by providing a foundation for those who are entering the field or who are involved in the field. We also hope this will help advance research by providing recommendations for clinical trials and by providing definitions that we hope [you] will find useful.”

The consensus document was updated by experts from the Heart Rhythm Society, European Cardiac Arrhythmia Society, European Heart Rhythm Association, American College of Cardiology, American Heart Association and Society of Thoracic Surgeons. Calkins said the complete document is expected to be published online in March. – by Casey Murphy

For more information:

• Calkins H. 2012 HRS consensus document on AF ablation. Presented at: The 17th Annual International Boston AF Symposium; Jan. 12-14, 2012; Boston.

Disclosure: Dr. Calkins is a consultant and on the advisory board for Atricure, Biosense Webster, Medtronic and Sanofi-Aventis.

Bruce Wilkoff

This document defines quality care of AF patients. It is a strong document because it represents the initial, clear consensus of the worldwide heart rhythm community. Forty-five of the most prominent experts from Europe, Asia and North America in both the medical and surgical communities collaborated to define the indications, techniques, terminology and management of the patients before, during and after surgical and catheter ablation therapy. Ablation for AF is strongly indicated for patients with symptomatic intermittent AF who have failed antiarrhythmic medications and is useful in the treatment in several other situations.

– Bruce Wilkoff, MD
Cardiology Today Editorial Board member

Disclosure: Dr. Wilkoff reports no relevant financial disclosures.

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