ESC Congress 2016 - 4

FEATuREd ARTIclE Table 2. Major Recommendations for Catheter Ablation of AF Recommendations Class Level I A Ablation of common atrial flutter should be considered to prevent recurrent flutter as part of an AF ablation procedure if flutter has been documented or occurs during the AF ablation. IIa B Catheter ablation of AF should be considered as first-line therapy to prevent recurrent AF and to improve symptoms in selected patients with symptomatic paroxysmal AF as an alternative to AAD, considering patient choice, benefit, and risk. IIa B Catheter ablation should target isolation of the pulmonary veins using radiofrequency ablation or cryothermy balloon catheters. IIa B AF ablation should be considered in symptomatic patients with AF and heart failure with reduced ejection fraction to improve symptoms and cardiac function when tachycardiomyopathy is suspected. IIa C Catheter or surgical ablation should be considered in patients with symptomatic persistent or long-standing persistent AF refractory to AAD therapy to improve symptoms, considering patient choice, benefit and risk, and supported by an AF Heart Team. IIa C Minimally invasive surgery with epicardial pulmonary vein isolation should be considered in patients with symptomatic AF when catheter ablation has failed. Decisions on such patients should be supported by an AF Heart Team. IIa B Maze surgery, possibly via a minimally invasive approach, performed by an adequately trained operator in an experienced center, should be considered by an AF Heart Team as a treatment option for patients with symptomatic refractory persistent AF or postablation AF to improve symptoms. IIa C Maze surgery, preferably biatrial, should be considered in patients undergoing cardiac surgery to improve symptoms attributable to AF, balancing the added risk of the procedure and the benefit of rhythm control therapy. IIa A Concomitant biatrial maze or pulmonary vein isolation may be considered in asymptomatic AF patients undergoing cardiac surgery. IIb C Catheter ablation of symptomatic paroxysmal AF is recommended to improve AF symptoms in patients who have symptomatic recurrences of AF on antiarrhythmic drug therapy and who prefer further rhythm control therapy, when performed by an electrophysiologist who has received appropriate training and is performing the procedure in an experienced center. AAD, antiarrhythmic drug; AF, atrial fibrillation. Adapted from Kirchhof P et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016. doi:10.1093/eurheartj/ehw210. By permission of Oxford University Press on behalf of the European Society of Cardiology. Table 3. Cardiovascular Risk Assessment Recommendations Recommendations Class Level I C It is recommended to repeat CV risk assessment every 5 years and more often for individuals with risks close to thresholds mandating treatment. I C Systematic CV risk assessment may be considered in men > 40 years of age and in women > 50 years of age or post menopausal with no known CV risk factors. IIb C Systematic CV risk assessment in men < 40 years of age and women < 50 years of age with no known CV risk factors is not recommended. III C Total CV risk estimation, using a risk estimation system such as SCORE, is recommended for adults > 40 years of age, unless they are automatically categorized as high risk or very high risk based on documented CVD, diabetes mellitus (> 40 years of age), kidney disease, or a highly elevated single risk factor. I C Systematic CV risk assessment is recommended in individuals at increased CV risk, ie, with family history of premature CVD, familial hyperlipidemia, major CV risk factors, or comorbidities increasing CV risk. CV, cardiovascular; CVD, cardiovascular disease; SCORE, Systematic Coronary Risk Evaluation. Adapted from Piepoli MF et a. 2016 European Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2016;37: 2315-2381. doi:10.1093/eurheartj/ehw106. By permission of Oxford University Press on behalf of the European Society of Cardiology. 4 October 2016 medicom-publishers.com/mcr http://www.medicom-publishers.com/mcr

Table of Contents for the Digital Edition of ESC Congress 2016