JACC This Week Ablation To Reduce Atrial Fibrillation Burden And Improve Outcomes: Jacc Review Topic of the Week
Aug 28, 2023
Dr. Valentin Fuster discusses the role of catheter ablation in reducing atrial fibrillation outcomes. Topics include measuring AF burden and optimal monitoring duration, the relationship between AF and heart failure, the use of ablation or pharmacologic rhythm control, and the impact of catheter ablation on healthcare use and outcomes.
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Better Way To Define AF Burden
- Atrial fibrillation (AF) burden is best quantified as percent time in AF, longest episode duration, or episode count rather than clinical labels alone.
- Continuous monitoring or repeated 28-day noninvasive monitoring gives the most accurate AF burden estimates.
AF Burden Predicts Worse Outcomes
- Higher AF burden correlates with worse outcomes including mortality and hospitalization across cohorts like ASSERT and ROCKET AF.
- AF coexisting with heart failure markedly increases morbidity and mortality versus either condition alone.
Offer Ablation For Symptomatic AF After Drugs
- Use catheter ablation for symptomatic AF patients who fail or can't tolerate antiarrhythmic drugs to improve quality of life.
- Multiple trials (CABANA, CIRCA-DOSE, DISCERN-AF) show ablation better preserves function and reduces symptoms than drugs.