2023 AHA / ACC AFIB GUIDELINES

Joglar, J, Chung, M. et al. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. JACC. 2024 Jan, 83 (1) 109–279

AFLUTTER + AFIB ABLATION INDICATIONS

Atrial Flutter Ablation Indications

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It is a class IIa indication for catheter based ablation for treatment of the
first episode of well tolerated atrial flutter

It is a class I indication for catheter based ablation for treatment of
recurrent, but well tolerated atrial flutter

It is a class I indication for catheter based ablation for treatment of poorly
tolerated atrial flutter

It is a class IIa indication for catheter based ablation for treatment of
symptomatic, non-CTI dependent flutter after failed AAD therapy. 

(Blomstrom-Lundqvist Sheinmen et al Guidelines for the management for the
patients with supraventricular arrhythmias; Circulation. 2003;108:1871-1909).

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PVI INDICATIONS

It is a class I indication for catheter based ablation in symptomatic paroxysmal
atrial fibrillation refractory or intolerant to at least 1 class I or class III
AAD. 

It is a class IIa indication for catheter based ablation in patients with
syptomatic persistent atrial fibrillation refractory or intolerant to at least 1
class I or class III AAD. 

It is a class IIa indication for catheter based ablation in patients with
recurrent symptomatic paroxysmal atrial fibrillation for an initial rhythm
control strategy before therapeutic trials of antiarrhythmic drug therapy, after
weighing the risks and outcomes of drug and ablation therapy

It is a class IIb indication for catheter based ablation for patients with
symptomatic long-standing (>12 months) persistent atrial fibrillation refractory
or intolerant to at least 1 class I or class III AAD 

It is a class III contraindication for afib ablation in patients who can not be
treated with anticoagulation during and after the procedure. 

It is a class III contraindication for afib ablation to restore sinus rhythm
with the sole intent of obviating the need for anticoagulation 

January, Craig et al. "2014 AHA/ACC/HRS Guideline for the Management of Patients
With Atrial Fibrillation" Circulation. 2014; 130: e199-e267