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Updated: Jun 9, 2025
Robotic Ablation of Atrial Fibrillation
Published on: May 29, 2015
An international physician survey of current ablation practices in atrial fibrillation: An AIM-AF substudy
Sanjeev Saksena1, April Slee2, Jose L Merino3
1Rutgers-Robert Wood Johnson Medical School, Piscataway, New Jersey; Electrophysiology Research Foundation, Warren, New Jersey.
Insights
Ablation (ABL) is often preferred over antiarrhythmic drugs (AADs) for atrial fibrillation (AF) rhythm control, even in asymptomatic cases. Post-ABL, AADs are frequently used for prophylaxis and managing recurrences, with amiodarone being common.
Area of Science:
- Cardiology
- Electrophysiology
- Pharmacology
Background:
- Practice guidelines recommend ablation (ABL) for atrial fibrillation (AF) rhythm control.
- Limited guidance exists for antiarrhythmic drug (AAD) use post-ABL.
Purpose of the Study:
- To determine current AAD and ABL practices in the United States and Europe.
Main Methods:
- An online survey was conducted among cardiologists (n=360) and interventional electrophysiologists (n=269).
- Responses regarding AAD and ABL practices were analyzed.
Main Results:
- ABL is frequently preferred as first-line AF therapy, particularly in the US.
- ABL is used for symptomatic, asymptomatic, and subclinical AF, and in heart failure patients.
- Post-ABL, AADs are commonly prescribed for prophylaxis and recurrence management, with amiodarone being the most frequent choice.
Conclusions:
- ABL is often favored over AADs for symptomatic AF and is also utilized in asymptomatic and subclinical AF.
- Post-ABL AAD use for prophylaxis and recurrence is common, with amiodarone frequently selected.
- Practices vary, highlighting a need for clearer guidance on AAD use after AF ablation.
Background:
Practice guidelines recommend ablation (ABL) in atrial fibrillation (AF) for rhythm control. Guidance for antiarrhythmic drugs (AADs) post-ABL is limited.
Objective:
The purpose of this study was to determine AAD and ABL practices in the United States and Europe.
Methods:
An online survey of experienced cardiologists (CDs) (n = 360) and interventional electrophysiologists (EPs) (n = 269) was conducted. AAD- and ABL-related survey questions and responses were analyzed.
Results:
ABL was preferred more often as first-line AF therapy (Rx) by US CDs/EPs (P ≤.001). ABL was selected to avoid AAD Rx by 46% (50% CDs, 40% EPs); to prevent AF progression by 41% (36% CDs, 47% EPs); and for superior efficacy by 28% (27% CDs, 30% EPs). ABL was used by 9% in asymptomatic AF (9% CDs, 10% EPs), by 14% in subclinical AF (13% CDs, 14% EPs), and by 17% for first AF event (15% CDs, 18% EPs). Primary ABL was preferred in heart failure by 38%. Comorbidities, age, and left atrial size were limitations for ABL by 48%, 40%, and 38%, respectively. AADs were used after ABL for AF/atrial tachycardia (AT) prophylaxis by 34% for 3-6 months and 29% for 1-2 months. AADs were given for a single AF recurrence by 34%, bridging to re-ABL by 32%, and long-term Rx by 34%. AF/AT post-ABL was most often managed with amiodarone (42%-48%).
Conclusion:
ABL was frequently preferred over AADs in symptomatic AF but notably also was used for asymptomatic and subclinical AF. Post-ABL AAD Rx for AF prophylaxis or recurrence was frequent, with empiric amiodarone being the most often selected AAD.
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