New 2026 AHA/ACC AF Measures — Part 2
New 2026 AHA/ACC AF Measures — Part 2
Ablation, HFrEF,
PCI & Antithrombotic Therapy
Antithrombotic Therapy & Stroke Prevention:
* AF + PCI: prefer DOAC + P2Y12 inhibitor; aspirin is generally stopped within 1–4 weeks rather than continuing prolonged triple therapy.
* AF + chronic coronary disease >1 year: in the absence of prior stent thrombosis, use OAC alone rather than OAC + antiplatelet therapy.
* Mechanical valve or moderate/severe mitral stenosis: do not use DOACs routinely → warfarin preferred.
Ablation
* Earlier ablation: Can be first-line therapy in selected symptomatic AF patients, without prior antiarrhythmic drug failure.
Example: younger, otherwise healthy patient with symptomatic paroxysmal AF.
* AF + HFrEF: Catheter ablation is Class I in appropriate patients, particularly when AF is contributing to LV dysfunction.
* PVI (Pulmonary Vein Isolation) remains the primary lesion set for AF ablation.
* AF during acute illness or surgery: patients should be told that recurrence is common; it should not automatically be considered a harmless transient episode.
https://www.jacc.org/doi/10.1016/j.jacc.2026.05.032