Current evidence on the safety and efficacy of percutaneous (non-thoracoscopic) epicardial catheter radiofrequency ablation for atrial fibrillation (AF) is inadequate in quantity. Therefore, this procedure should only be used with special arrangements for clinical governance and consent.
Clinicians wishing to undertake percutaneous (non-thoracoscopic) epicardial catheter radiofrequency ablation for AF should take the following actions.
Inform the clinical governance leads in their Trusts.
Ensure that patients understand the uncertainty about the procedure's safety and efficacy and provide them with clear written information. In addition, the use of NICE's information for the public is recommended.
Patient selection and treatment should be carried out only by a team specialising in the treatment of cardiac arrhythmias that includes experts in electrophysiology and ablation.
The procedure should only be carried out by interventional cardiologists with specific training in electrophysiology, and in accessing the pericardial space and performing complex ablation procedures.
The procedure should only be carried out in units with arrangements for emergency cardiac surgical support in case of complications.
The National Institute for Cardiovascular Outcomes Research runs the UK Central Cardiac Audit Database (UKCCAD) and clinicians should enter details about all patients undergoing percutaneous (non-thoracoscopic) epicardial catheter radiofrequency ablation for AF onto this database.
Clinicians are encouraged to enter patients into research studies that aim to provide more information about patient selection, the use of this procedure as an adjunct to other procedures, freedom from AF in the long term and relief of associated symptoms, and the safety profile of the procedure. NICE may review the procedure on publication of further evidence.