AF Ablation Consensus Will Enable Better Care
“Electrophysiologists should perform several ablation procedures per month if they intend to be active in this area,” Dr. Calkins said. “Is 'several' two, three, four? It's somewhere in that range.”
Although numerous techniques have been developed for AF catheter ablation, the panel said that targeting the pulmonary veins and/or antrum is the cornerstone of most procedures, and that the goal in targeting the pulmonary veins is their complete electrical isolation. For surgical isolation of the pulmonary veins, entrance and/or exit block must be demonstrated.
Dr. Kowey balked at calling the report a practice guideline.
“It's a valuable document that summarizes the state of the art. The reason it shouldn't be considered a guideline is because almost everything that's in this document doesn't have solid scientific data to support it,” he said. “You don't see things that typify guidelines, like the class of the recommendations or weight of the evidence, A through C, because the evidence doesn't exist.”
Dr. Josep Brugada, co-chair of the report task force, conceded the point.
“The growth in technique has been far ahead of the scientific evidence,” observed Dr. Brugada, president-elect of the European Heart Rhythm Association and chief of cardiology at the University of Barcelona Hospital Clinic. “We might have to change our minds a few years from now. We said, for example, that pulmonary vein isolation is the cornerstone of atrial fibrillation ablation. We believe it's true, it probably is, but we might be wrong. We have to wait.”
The document's greatest contribution, panelists agreed, it that it imposes for the first time a common language on the young and rapidly evolving field of atrial fibrillation ablation. It defines the training and technical competence needed to perform the procedure, complications, appropriate follow-up and long-term management, and a recommended anticoagulation regimen, and it insists that henceforth all reported success rates must include figures on single-session outcomes.
“I can't tell you how many papers I've read where you can't figure out how many ablation procedures patients have gotten,” Dr. Ellenbogen complained.
The consensus statement will prove invaluable as a teaching tool for the swelling ranks of physicians just starting out in atrial fibrillation ablation, panelists said.
Up until now, Dr. Brugada pointed out, how-to-do-it workshop attendees were likely to hear five markedly different opinions from any five leading experts.
The consensus statement hammers out minimum points of agreement.
“For people who don't have a lot of expertise, to have this collective wisdom distilled in a document is a great gift,” according to Dr. Callans.
The consensus document is available at www.hrsonline.org/Policy/ClinicalGuidelines
'It's a valuable document that summarizes the state of the art [but] it shouldn't be considered a guideline.' DR. KOWEY
