Radiofrequency Catheter Ablation (RFCA) as second-line ... - NHS

8. The prevalence of AF in the UK is rising and demand for RFCA is likely to increasebeyond that which affordable.16. Recommendations:Services to provide this treatment may be commissioned by East Midlands SpecialisedCommissioning Group in accordance with regional priority setting. In accordance with NICE CG36 and NICE IPG 168, this treatment should only be funded* by the East Midlands SpecialisedCommissioning Group in patients who meet all of the following criteria:1) The patient has severely symptomatic and debilitating paroxysmal atrial fibrillationwhich has a significant impact on the patient’s quality of life, indicated by frequent andprolonged episodes of EHRA Class III or IV.AND2) The patient’s symptoms are refractory (ineffective or intolerant) to two or more antiarrhythmicdrugs (including ß-blockers), as recommended by the NICE Clinical Guideline36: management of atrial fibrillation.AND3) The patient has been referred to an experienced interventional cardiologist with specifictraining in electrophysiology and performing complex ablation procedures, at a centrewith arrangements for emergency cardiac surgical support in case of complications.AND4) The patient has discussed with the specialist interventional cardiologist, realisticexpectations of the effectiveness including an acceptance of a 5% risk of seriouscomplications and the potential requirement of a second ablation procedure.AND5) The patient has an absence of severe structural heart disease on echocardiography,including the absence of a severely dilated left atrium (maximum 5.5 cm).AND6) The patient does not meet any of the following exclusion criteria17. Exclusion criteria• Permanent or Persistent AF• Patient is due to undergo heart surgery (e.g. value repair/CABG) and would bean appropriate case for concomitant surgical ablation (cox maze)• Severe and/or irreversible structural heart disease• Left atrial thrombus on echocardiography• NYHA class IV congestive heart failure• Life expectancy less than 5 yearsDr Lauren Ahyow. RFCA for the treatment of atrial fibrillation. August 2010. 13