In the relevant guidelines, the recommendation level of catheter ablation in the treatment of atrial fibrillation is becoming higher and higher. At ACC 2023, a number of studies on the ablation of atrial fibrillation were released. Professor Rajesh Kabra from the University of Tennessee Health Science Center was invited by this journal to provide in-depth analysis about the hot topics of the conference.
International Circulation: In the guidelines, the recommendation level of catheter ablation in the treatment of atrial fibrillation is becoming higher and higher. What is the latest clinical evidence of catheter ablation at this conference?
Professor Rajesh Kabra: There is more and more evidence coming from different randomized studies for offering catheter ablation as a first-line treatment for atrial fibrillation. We are going to touch on some of these studies tomorrow in the Electrophysiology Highlights Section, but I think the data are very encouraging. There are now several randomized studies to support the evidence, so I think in the near future, we will see more and more patients with atrial fibrillation being offered catheter ablation as a first-line treatment, because anti-arrhythmic drugs have poor efficacy and long term side effects.
International Circulation: Currently, what are the commonly used catheter ablation strategies and tools in clinical practice?
Professor Rajesh Kabra: Currently, we use different strategies for atrial fibrillation ablation, but pulmonary vein isolation is the cornerstone of any AF ablation, and that can be achieved either with radiofrequency ablation, cryoballoon ablation, and lately, there has been a lot of excitement about pulsed-field ablation. Tomorrow, again, we are going to see the results of the first AF study, where they are going to present the data of outcomes of pulsed-field ablation in patients with paroxysmal and persistent atrial fibrillation. So these are the different modalities that are currently being used. Even different approaches exist. While everyone uses pulmonary vein isolation for AF ablation, the jury is still out as to the other targets to better ablate AF or decrease recurrence. There are studies showing that triggers might be important. There are studies showing that substrate modification might be important. There is a lot of interest in a publication about vein of Marshall ablation to improve outcomes in atrial fibrillation. But I am really looking forward to the results of the pulse-field study being presented tomorrow, because pulse-field ablation has really seen exciting developments in the field, and the preliminary studies have shown great efficacy with minimal complications.
International Circulation:What are the common complications after catheter ablation? How to improve the effectiveness and safety of catheter ablation?
Professor Rajesh Kabra: There has been a recent publication from the NCDR Registry that shows that AF ablation has become a really safe procedure with really low complication rates (<1 in 100). The common complications are associated with groin bleeding and injury to the vessels, but things like tamponade, stroke, esophageal injury and mortality have been extremely rare based on recent studies and recent data, even in the real world NCDR Registry atrial fibrillation ablation real world data.
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