Key result
Catheter ablation for AF remains indicated only for symptomatic patients despite ~40% being asymptomatic.
Why the study?
Does catheter ablation reduce mortality or stroke in patients with asymptomatic atrial fibrillation?
Does catheter ablation reduce mortality or stroke in patients with asymptomatic atrial fibrillation?
This review explores the rationale and existing data for performing catheter ablation in asymptomatic atrial fibrillation patients, an indication not currently supported by guidelines due to a lack of randomized mortality or stroke data.
Since the original description of atrial fibrillation ablation, numerous studies have demonstrated the superiority of catheter ablation over pharmacological therapy for maintenance of sinus rhythm in patients with both paroxysmal and persistent atrial fibrillation. However, to date, no randomized studies have been powered to demonstrate a mortality or stroke reduction benefit of rhythm control with catheter ablation over a rate control strategy. The results of such ongoing studies are not expected until 2018 or 2019. Thus, the only indication for atrial fibrillation ablation in recent guidelines has been the presence of symptoms. However, up to 40% of an atrial fibrillation population may be asymptomatic. In 2017, in the absence of randomized studies, are there nevertheless data that support atrial fibrillation ablation in asymptomatic patients?
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Kalman et al. (2017) conducted a review in Asymptomatic Atrial Fibrillation. Catheter ablation vs. Pharmacological therapy was evaluated. Catheter ablation for atrial fibrillation is currently indicated only for symptomatic patients, although up to 40% of the atrial fibrillation population may be asymptomatic.
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