American College of Cardiology
View all recommendations from this societyReleased February 23, 2023
Avoid performing atrial fibrillation ablation for the sole purpose of discontinuing chronic anticoagulation.
Catheter ablation is an important tool to reduce symptoms and improve quality of life for appropriately selected patients with atrial fibrillation (AF). However, there are no randomized trials demonstrating that anticoagulation can be safely discontinued after ablation in patients with elevated stroke risk. US cardiology society and international electrophysiology society guidelines and consensus statements recommend that continuation of oral anticoagulation after catheter ablation should be guided by a patient’s stroke risk profile rather than the perceived success of the procedure. Therefore discontinuation of anticoagulation should not be the sole motivating factor for undertaking AF ablation. Informed consent and shared decision making should include a discussion of the indication to continue anticoagulation as indicated by standard stroke risk scores and clinical practice guidelines.
These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.
How The List Was Created
The American College of Cardiology (ACC) formed a Choosing Wisely workgroup of member leaders from the Board of Governors, subspecialty experts, and health policy specialists. The workgroup was tasked with identifying five clinical scenarios where specific tests, treatments, or procedures should be avoided for lack of benefit. These five recommendations were pulled from ACC’s existing appropriate use criteria (AUC) and clinical practice guidelines, selecting items that were either Rarely Appropriate AUC indications or Class III guideline recommendations. The ACC’s Clinical Policy Approval Committee and Science & Quality Committee then reviewed and approved the final five items.
ACC’s disclosure and conflict of interest policy can be found at www.acc.org/about-acc/industry-relations/principles-for-relationships-with-industry
Sources
January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2014;64:e1-76.
Calkins H, Hindricks G, Cappato R, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm. 2017;14:e275-e444.
