left atrial ablation and pace and ablate therapy in atrial fibrillation (AF)

Last edited 05/2021 and last reviewed 05/2021

NICE atrial fibrillation guidance states (1):

• pace and ablate strategy
  • consider pacing and atrioventricular node ablation for people with permanent atrial fibrillation with symptoms or left ventricular dysfunction thought to be caused by high ventricular rates
    
    
  • when considering pacing and atrioventricular node ablation, reassess symptoms and the consequent need for ablation after pacing has been carried out and drug treatment further optimised
    
    
  • consider left atrial catheter ablation before pacing and atrioventricular node ablation for people with paroxysmal atrial fibrillation or heart failure caused by non-permanent (paroxysmal or persistent) atrial fibrillation
    
    
• left atrial ablation
  
  
  • if drug treatment is unsuccessful, unsuitable or not tolerated in people with symptomatic paroxysmal or persistent atrial fibrillation:
    • consider radiofrequency point-by-point ablation or
    • if radiofrequency point-by-point ablation is assessed as being unsuitable, consider cryoballoon ablation or laser balloon ablation
      
      
  • consider left atrial surgical ablation at the same time as other cardiothoracic surgery for people with symptomatic atrial fibrillation
    
    
• preventing recurrence after ablation
  • consider antiarrhythmic drug treatment for 3 months after left atrial ablation to prevent recurrence of atrial fibrillation, taking into account the person's preferences, and the risks and potential benefits
  • reassess the need for antiarrhythmic drug treatment at 3 months after left atrial ablation

Reference:

• NICE (April 2021). Atrial fibrillation: the management of atrial fibrillation