Atrial fibrillation ablation timing: where is the sweet spot?

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dc.contributor.authorKalman, J.M.
dc.contributor.authorKistler, P.M.
dc.contributor.authorHindricks, G.
dc.contributor.authorSanders, P.
dc.date.issued2025
dc.descriptionPublished: 03 January 2025
dc.description.abstractConvincing evidence for the efficacy of ablation as first-line therapy in paroxysmal AF (PAF) and its clear superiority to medical therapy for rhythm control in both PAF and persistent AF (PsAF) has generated considerable interest in the optimal timing of ablation. Based on this data, there is a widespread view that the principle of 'the earlier the better' should be generally applied. However, the natural history of AF is highly variable and non-linear, and for this reason, it is difficult to be emphatic that all patients are best served by ablation early after their initial AF episodes. Sufficient evidence exists to indicate a conservative approach is reasonable in patients with infrequent and non-progressive episodes (i.e. absence of progressive increase in burden culminating in PsAF) in whom symptoms remain mild and well-controlled. A conservative management phase should be marked by assiduous attention to risk factor modification, changes in frequency and duration of AF episodes, and patient preferences. If and when AF does begin to progress, accumulating evidence indicates that early ablation accompanied by ongoing attention to risk factors provides the best outcomes.
dc.description.statementofresponsibilityJonathan M. Kalman, Peter M. Kistler, Gerhard Hindricks, and Prashanthan Sanders
dc.identifier.citationEuropean Heart Journal, 2025; 46(9):805-813
dc.identifier.doi10.1093/eurheartj/ehae892
dc.identifier.issn0195-668X
dc.identifier.issn1522-9645
dc.identifier.orcidSanders, P. [0000-0003-3803-8429]
dc.identifier.urihttps://hdl.handle.net/2440/143852
dc.language.isoen
dc.publisherOxford University Press
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/2017798
dc.rights© The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved.
dc.source.urihttps://doi.org/10.1093/eurheartj/ehae892
dc.subjectAblation
dc.subjectAtrial fibrillation
dc.subjectNatural history
dc.subjectRisk factor management
dc.titleAtrial fibrillation ablation timing: where is the sweet spot?
dc.typeJournal article
pubs.publication-statusPublished

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