Atrial Fibrillation Guidelines

CE / CME

Charting a Course for Success: Navigating New Guidelines in Atrial Fibrillation Management and Treatment

Physician Assistants/Physician Associates: 1.00 AAPA Category 1 CME credit

Nurses: 1.00 Nursing contact hour

Pharmacists: 1.00 contact hour (0.1 CEUs)

Physicians: maximum of 1.00 AMA PRA Category 1 Credit

Released: June 26, 2024

Expiration: June 25, 2025

Christopher B. Granger
Christopher B. Granger, MD

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2023 ACC/AHA Guidelines: Updated Recommendations on Catheter Ablation in Patients With Atrial Fibrillation

Listen to this brief audio clip about the merits of early rhythm control for patients with atrial fibrillation.

Early rhythm control for patients who have relatively new onset atrial fibrillation is associated with improved outcome, less hospitalization, and fewer clinical events around atrial fibrillation.30 The 2023 ACC/AHA guideline on atrial fibrillation now indicates that catheter ablation now has a Class 1 recommendation for first-line treatment for selected patients. These include younger patients with fewer comorbidities with symptomatic paroxysmal atrial fibrillation.

2023 ACC/AHA Guidelines: Recommendations on Anticoagulation After Catheter Ablation in Patients With Atrial Fibrillation

Another key recommendation refers to anticoagulation after catheter ablation. If patients have risk factors for stroke, eg, CHA2DS2-VASc ≥2, they should continue anticoagulation.1 Approximately one third of patients undergoing ablation will have recurrent atrial fibrillation,31 so continued anticoagulation is important in this population.

2023 ACC/AHA Guidelines: Catheter Ablation

Catheter ablation for appropriate patients with heart failure—especially for those with reduced ejection fraction—has received a Class 1 recommendation, again based on several clinical trials including the RAFT trial. This diagram is from the 2023 ACC/AHA Guidelines.1

Patients likely to benefit from catheter ablation include those with:

  • Atrial fibrillation‒mediated cardiomyopathy (eg, patients with rapid ventricular response whose cardiomyopathy may be because of tachycardia)
  • Earlier stages of heart failure
  • No significant scarring on MRI
  • No or mild atrial fibrosis
  • No increase in atrium size
  • Paroxysmal or newly persistent atrial fibrillation
  • Younger patients without significant comorbidities

If patients have heart failure with reduced ejection fraction, there is a Class 1 recommendation for ablation as the best approach for rhythm control. However, if they have heart failure with preserved ejection fraction, then ablation should be considered (Class 2a recommendation).

The far-right panel of the slide includes recommendations for ablation of the atrioventricular node and inserting a pacemaker. This Class 2a-2b recommendation includes patients with continued refractory challenges with rate control who may benefit from this approach.