Catheter Ablation of Atrial Fibrillation: Current and Evolving Indications

• Published in: Canadian journal of cardiology 2020-10, Vol.36 (10), p.1685-1689
• Main Authors: AlTurki, Ahmed, Joza, Jacqueline, Bernier, Martin L., Proietti, Riccardo, Essebag, Vidal
• Format: Article
• Language: English
• Subjects: Atrial Fibrillation - surgery; Catheter Ablation - methods; Humans; Patient Selection; Practice Guidelines as Topic
• ISSN: 0828-282X; 1916-7075
• DOI: 10.1016/j.cjca.2020.01.012

Catheter ablation (CA) was developed as a potentially curative procedure through electrical isolation of the pulmonary veins to isolate the main triggers of atrial fibrillation (AF). When successful, CA has clearly been shown to decrease AF recurrence and symptoms, and improve quality of life. With advancing technology, increased procedural success, and lower complication risk, CA is being used at much higher rates, with broader indications and in a diverse AF population. Symptomatic paroxysmal AF that is refractory to antiarrhythmic drugs is currently the indication for CA with the best evidence. CA for AF as first-line therapy is reserved for highly selected symptomatic patients with paroxysmal AF. Current studies have not shown an improvement in mortality or quality of life with CA as first-line therapy. In patients with persistent AF who are symptomatic despite medical therapy, CA is a reasonable therapeutic option. Although recent trials have suggested that CA reduced mortality and hospitalizations in patients with heart failure and reduced ejection fraction, the evidence is not conclusive. Therefore, current guidelines recommend CA for similar indications to patients without heart failure, but large trials comparing CA with strict rate control will be reported in the near future. Ongoing studies will assess whether CA of AF reduces major adverse cardiovascular events and whether stopping anticoagulation in the long term is possible after CA. The purpose of this review is to outline the current and evolving indications for CA of AF and the underlying evidence supporting these indications. L’ablation par cathéter (AC) est une intervention à visée curative reposant sur l’isolation électrique des veines pulmonaires, où se trouvent les principaux foyers déclencheurs de la fibrillation auriculaire (FA). Il a été démontré clairement que lorsqu’elle est réussie, l’AC diminue la récurrence de la FA et en atténue les symptômes, ce qui améliore la qualité de vie du patient. Grâce aux avancées technologiques, à l’augmentation de la réussite de l’intervention et à un faible risque de complications, l’AC est de plus en plus utilisée pour des indications de plus en plus larges au sein d’une population diversifiée de patients atteints de FA. La FA paroxystique symptomatique réfractaire aux antiarythmiques est l’indication de l’AC pour laquelle on dispose à l’heure actuelle des données les plus probantes. L’AC utilisée comme traitement de première intention de la FA