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The guidelines recommend that anticoagulation should be based in CHADS score and not AF recurrence after AF ablation. Discontinuation of warfarin therapy post ablation is generally not recommended in patients who have a (CHADS) score ≥ 2.The guidelines based outcome of > 30 seconds of AF indicating a failure of ablation is too strict in my opinion, but this has not changed in the recent guideline update. However, if we are going to be able to gauge improvements in outcome across different centers and techniques then we need a clear comparator, and single procedure success rate off antiarrhythmic medications should remain that barometer for AF ablation outcome. Clinically, it is well recognized that many patients do well with the combination of antiarrhythmic drugs and catheter ablation, and that a second ablation procedure may be required. When reading the literature, an endpoint of freedom from AF after multiple procedures including patients on antiarrhythmic therapy is often provided as the primary endpoint, and teasing out the single procedure success rate may be difficult. Freedom from AF/flutter/tachycardia off antiarrhythmic therapy after a single ablation procedure is the primary endpoint of AF ablation.Our practice is to perform continuous 2-week monitoring at 6 months and 1 year after AF ablation in all patients. There are multiple types of transtelephonic monitors available, including those that perform continuous monitoring for up to 30 days and those that have an autotrigger feature to detect asymptomatic arrhythmias. Therefore, both to determine the outcome after ablation and to guide decisions about anticoagulation (see #7), some prolonged monitoring to detect asymptomatic AF after ablation should be performed at any center performing AF ablations.
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3 The mechanism for this is not clearly understood, but likely relates to some denervation of the atrium with ablation. Multiple studies have demonstrated that symptoms of palpitations from AF are reduced after ablation.
#Ablation of atrial flutter icd 10 pcs trial#
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Of course, rare patients with severe symptoms from recurrent atypical flutter refractory to antiarrhythmic drugs and cardioversion may require repeat ablation earlier than 3 months. In a study by Haissaguerre and colleagues, 2 early redo ablation led to an increase in procedures with no reduction in freedom from AF at approximately 1 year. 1 While early AF recurrence is one of the strongest predictors of late recurrence, the additional risks of a second ablation within 3 months of the first, including groin complications, additional radiation, the possibility that late pulmonary vein reconnection has not yet occurred and the additional cost argue that watchful waiting in the months after ablation is the most prudent strategy. Multiple studies have demonstrated that 30-50% of early recurrences of atrial fibrillation and atypical flutter do resolve on their own, particularly after ablation in patients with persistent AF. Repeat procedures should be delayed for at least three months following initial ablation, if the patient’s symptoms can be controlled with medical therapy.2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. Editor's Note: This Hot Topic is based on Calkins H, Kuck KH, Cappato R, et al.