Revised ablation guidelines previewed at Boston AF


At Boston AF, Hugh Calkins (director of Cardiac Arrhythmia Service, Johns Hopkins Medical Center, Baltimore, Maryland, USA) gave a sneak preview of the forthcoming 2012 Heart Rhythm Society (HRS), European Heart Rhythm Association (EHRA), and European Cardiac Arrhythmia Society (ECAS) consensus document on catheter ablation for atrial fibrillation.

Calkins explained that the new guidelines, which are due to published in early March, are an update of the 2007 HRS/EHRA/ECAS catheter ablation (for atrial fibrillation) guidelines. However, he stressed that they were not a “brief update” but a “comprehensive review” of catheter and surgical ablation for atrial fibrillation. He added that the new guidelines ran to 210 pages and had 11 different sections.

Regarding what the changes were in the new guidelines compared with the 2007 guidelines, Calkins said that the “biggest change” was that the guidelines now specified the class and level of evidence for catheter ablation for different types of atrial fibrillation (paroxysmal, persistent, and long-standing persistent).

Another major change was that HRS/EHRA/ECAS now recommend using the CHADS2-VASc score as well as the CHADS2 score to assess a patient’s risk of stroke after undergoing catheter ablation. Importantly, Calkins added, they had spent a lot of time on the use of anticoagulation in patients with atrial fibrillation. He explained that they had taken a “very conservative” approach and did not recommend discontinuing the use of anticoagulation in patients who were deemed to be at high risk of stroke regardless of the presence of atrial fibrillation (post ablation).

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