From PCI MENA – AF & Atrial Flutter Ablation: Class of Recommendation
From PCI MENA – AF & Atrial Flutter Ablation: Class of Recommendation
(Based on EHRA/EAPCI Consensus Documents)
• AF Ablation
• Class I: Symptomatic paroxysmal AF, failed ≥1 AAD(AAD stands for Antiarrhythmic Drug).
• Class IIa: Persistent AF or first-line in selected patients
• Class IIb: Asymptomatic or HF patients (selectively)
• Atrial Flutter Ablation
• Class I: First-line for typical (CTI-dependent) flutter
• AF Ablation in HFrEF
• Class IIa: May reduce mortality/hospitalizations (CASTLE-AF)
Summary:
• AF ablation decisions depend on symptoms, drug failure, and patient profile
• Atrial Flutter ablation is more straightforward: first-line regardless of symptoms.
Summary – Treatment Pathway
1. First presentation – Paroxysmal AF
• Lifestyle changes + rate control
• If symptoms persist → rhythm control
• If drug fails → ablation (Class I)
2. Persistent AF
• Try medications first
• If failure or in selected cases → ablation (Class IIa)
3. Asymptomatic or Heart Failure patients
• Consider ablation selectively (Class IIb)
• Especially in HFrEF based on CASTLE-AF trial.
• Left atrial size plays a key role in AF management. Patients with a normal or mildly enlarged left atrium (≤4.0 cm in men, ≤3.8 cm in women) tend to have better outcomes after ablation, especially in paroxysmal AF. In contrast, a left atrial diameter >4.6–5.2 cm suggests more advanced disease, is more common in persistent AF, and may lead to lower success rates after ablation. Therefore, measuring LA size by echocardiography helps guide treatment decisions and patient selection.