EP Europace supplement:  the present and future AF ablation 

Get up to speed on the latest evidence supporting

catheter ablation for the treatment of atrial fibrillation 



Catheter ablation of atrial fibrillation: recent advances and future challenges

Authors: Prof. Dr. Gerhard Hindricks and Prof. Dr. Douglas Packer

Summary: The supplement highlights new findings and evidence that further develop catheter ablation of atrial fibrillation (AF) as the standard therapy for AF rhythm control. The papers are a substantial contribution to the ongoing discussion on the role, relevance, and future perspective of catheter ablation for the treatment of AF.


The 2020 ESC AF guidelines for AF catheter ablation, CABANA, and EAST

Authors:  Prof. Dr. Elena Arbelo and Dr. Nikolaos Dagres 

The manuscript provides an update to the latest ESC 2020 guidelines with regards to the decision to opt for rhythm control and the considerations around the type of long-term rhythm control strategy based on latest clinical evidence from the CABANA and  EAST-AFNET 4 trials.  

The CABANA trial and the EAST trial are probably the most relevant trials in the field of rhythm control for AF that have been published either shortly before or practically simultaneously with the 2020 ESC guidelines.

Prof. Dr. Elena Arbelo and Dr. Nikolaos Dagres

What we have learned: is pulmonary vein isolation still the cornerstone of atrial fibrillation ablation?

Authors: Prof. Dr. Andreas Metzner, Prof. Dr. Karl-Heinz Kuck and

Prof. Dr. Julian K R Chun

The paper focuses on the past, the present, and the future value of pulmonary vein isolation (PVI) as the cornerstone for interventional treatment of AF. It also discusses how to achieve durable PVI during the first procedure and to further improve the clinical success rates of AF ablation. The manuscript also analyses extended ablation strategies going beyond PVI and their impact. 


New evidence: cryoballoon ablation vs antiarrhythmic drugs for first-line therapy of atrial fibrillation

Authors:  Prof. Dr. Jason Andrade, Prof. Dr. Gian-Battista Chierchia, Dr. Malte Kuniss and

Prof. Dr. Oussama Wazni

The paper summarizes the latest evidence in favor of cryoballoon ablation versus antiarrhythmic (AAD) drugs for first-line therapy of AF. The current data suggests that the relative benefit of ablation (vs. AAD therapy) does not differ between those patients with paroxysmal and persistent AF. It also points to early catheter ablation.

“An initial treatment strategy of first-line cryoballoon ablation has been shown to be superior to AAD therapy for patients.”

Prof. Dr. Jason Andrade,  Prof. Dr. Gian-Battista Chierchia, Dr. Malte Kuniss And Prof. Dr. Oussama Wazni 

Atrial fibrillation progression and the importance of early treatment for improving clinical outcomes

Authors: Dr. Melanie Gunawardene and Prof. Dr. Stephan Willems

This review illuminates current evidence regarding the hypothesis of early treatment to prevent AF progression and improve clinical outcomes. The progression of AF is linked to negative cardiovascular outcomes (stroke, systemic embolism, and hospitalization due to heart failure). Consequently, there is a profound rationale for early treatment of AF as a cornerstone of AF management.

…there is a profound rationale for early treatment in order to prevent progression and improve clinical outcome as a cornerstone of AF management.

Dr. Melanie Gunawardene, Prof. Dr. Stephan Willems

Reflections on the usefulness of today’s atrial fibrillation ablation procedure endpoints and patient-reported outcomes

Authors: Prof. Dr. Carina Blomström-Lundqvist and Dr. Victoria Svedung Wettervik

The manuscript, while reviewing the current literature, gives a comprehensive overview of PROMs (patient-reported outcome measures) and their applicability in AF ablation. It recommends that AF ablation trials should have a Quality of Life measure as a primary endpoint and that PROMs should be used. In addition the paper highlights that AF-burden, continuously measured with implanted loop recorders or wearables (Smartwatch, etc.), should be used as a complementary electrical outcome and to better understand the treatment effect in different cohorts.

New energy sources and technologies for atrial fibrillation catheter ablation    

Author: Prof. Dr. Lucas Boersma

The manuscript is a review of the evolving energy sources and technologies for AF catheter ablation. While the future looks bright, the promise of these new energies and technologies needs to transform into durable and consistent performance in everyday clinical practice in the hands of every electrophysiologist.