Role of Catheter Ablation as a First-Line Treatment for Atrial Fibrillation
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Arrhythmia (R Kabra, Section Editor)
Role of Catheter Ablation as a First-Line Treatment for Atrial Fibrillation Ibrahim El Masri, MD1 Sharif M Kayali, DO2 Theodore Manolukas, DO2 Yehoshua C. Levine, MD3,* Address 1 Department of Cardiology, The University of Tennessee, 956 Court Ave, Memphis, TN, 38163, USA 2 Department of Internal Medicine, The University of Tennessee, Memphis, TN, 38163, USA *,3 Cardiac Electrophysiology, Methodist le Bonheur Healthcare, 1211 Union Avenue, suite 475, Memphis, TN, 38104, USA Email: [email protected]
Published online: 10 October 2020 * Springer Science+Business Media, LLC, part of Springer Nature 2020
This article is part of the Topical Collection on Arrhythmia Keywords Atrial fibrillation I Pulmonary vein isolation I Cryoballoon I Radiofrequency ablation I Pulsed field ablation
Abstract Purpose of review Catheter ablation has emerged as the most effective long-term rhythm controlling strategy in patients with symptomatic atrial fibrillation (AF). Over the last few years, the role of ablation has shifted from a last-resort strategy toward a first-line approach in AF management. The purpose of this review is to highlight the rationale behind an early ablation strategy and to summarize recent data regarding its effectiveness. Recent findings Pulmonary vein isolation (PVI), the cornerstone of catheter ablation of AF, is superior to antiarrhythmic drugs (AADs) in preventing recurrence of AF. PVI is most effective when performed early in the disease process. Recent studies have shown significant long-term benefit in patients treated with PVI early after AF diagnosis and/ or prior to use of AADs. Summary PVI is emerging as a highly appropriate first-line therapy for patients with symptomatic AF. As ablation technologies continue to improve, offering PVI to patients with recently diagnosed atrial fibrillation may become standard of care.
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Curr Treat Options Cardio Med (2020) 22: 38
Introduction Atrial fibrillation (AF) is the most common arrhythmia in the USA, with an estimated 2.7 to 6.1 million Americans suffering from this disease. These numbers will likely increase as life expectancy prolongs [1]. It has been estimated that the prevalence of AF in developed countries is as high as one in four middle-aged adults. Treatment of AF is aimed at reducing symptoms and preventing risk of cardioembolic events and arrhythmia-related cardiomyopathy. For many years, pharmacological therapy remained the mainstay of AF management, either with the use of drugs that slow conduction through the atrioventricular (AV) node or with the use of antiarrhythmic drugs (AADs) for rhythm control. The pendulum has shifted toward a rhythm controlling strategy in symptomatic patients with paroxysmal and persistent AF [2]. Rhythm control is also preferred in patients with congestive heart failure and left ventricular systolic dysfunction thought to be secondary to atrial fibrillation in an attempt to halt irreversible cardiac electrical and structural remodeling [3]. Many patients managed wi
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