title: Ablation of Atrial Fibrillation: Patient Selection, Periprocedural Anticoagulation, Techniques, and Preventive Measures After Ablation.
abstract: Atrial fibrillation (AF) is the most common arrhythmia encountered by cardiologists and is a major cause of morbidity and mortality. Risk factors for AF include age, male sex, genetic predisposition, hypertension, diabetes mellitus, sleep apnea, obesity, excessive alcohol, smoking, hyperthyroidism, pulmonary disease, air pollution, heart failure, and possibly excessive exercise. The management of AF involves decisions about rate versus rhythm control. Asymptomatic patients are generally managed with rate control and anticoagulation. Symptomatic patients will desire rhythm control. Rhythm control options are either antiarrhythmic agents or ablation, with each having its own risks and benefits. Ablation of AF has evolved from a rare and complex procedure to a common electrophysiological technique. Selection of patients to undergo ablation is an important aspect of AF care. Patients with the highest success rates of ablation are those with normal structural hearts and paroxysmal AF, although those with congestive heart failure have the greatest potential benefit of the procedure. Although pulmonary vein isolation of any means/energy source is the approach generally agreed on for those with paroxysmal AF, optimal techniques for the ablation of nonparoxysmal AF are not yet clear. Anticoagulation reduces thromboembolic complications; the newer anticoagulants have eased management for both the patient and the cardiologist. Aggressive management of modifiable risk factors (hypertension, diabetes mellitus, sleep apnea, obesity, excessive alcohol, smoking, hyperthyroidism, pulmonary disease, air pollution, and possibly excessive exercise) after ablation reduces the odds of recurrent AF and is an important element of care.
authors.affiliation: From Cardiac Arrhythmia Center, UT Southwestern Medical Center, Dallas, TX (M.S.L.); Liryc Institute (Electrophysiology and Heart Modeling Institute), Hopital Cardiologique du Haut-Leveque, CHU Bordeaux, Universite de Bordeaux, France (M.H.); and Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (A.N.). Mark.Link@UTSouthwestern.edu.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Link
authors.affiliation: From Cardiac Arrhythmia Center, UT Southwestern Medical Center, Dallas, TX (M.S.L.); Liryc Institute (Electrophysiology and Heart Modeling Institute), Hopital Cardiologique du Haut-Leveque, CHU Bordeaux, Universite de Bordeaux, France (M.H.); and Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (A.N.).
authors.forename: Michel
authors.initials: M
authors.lastname: Haïssaguerre
authors.affiliation: From Cardiac Arrhythmia Center, UT Southwestern Medical Center, Dallas, TX (M.S.L.); Liryc Institute (Electrophysiology and Heart Modeling Institute), Hopital Cardiologique du Haut-Leveque, CHU Bordeaux, Universite de Bordeaux, France (M.H.); and Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (A.N.).
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use; D058070:Asymptomatic Diseases; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods; D003452:Cryosurgery / Q000379:methods; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000379:methods; D008297:Male; D018579:Patient Selection; D011182:Postoperative Care / Q000379:methods; D011292:Premedication; D011300:Preoperative Care / Q000379:methods; D011667:Pulmonary Veins / Q000601:surgery; D012307:Risk Factors; D012720:Severity of Illness Index; D019851:Thrombophilia / Q000188:drug therapy / Q000209:etiology
chemical_list: D000889:Anti-Arrhythmia Agents; D000925:Anticoagulants
keywords: ablation techniques; anti-arrhythmia agents; anticoagulants; atrial fibrillation; pulsed radiofrequency treatment