Ablation First-line 2024 Upgrade — EECC MCQ
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Correct answer: D — Catheter ablation is recommended as first-line rhythm control (Class I for paroxysmal AF, Class IIa for persistent AF) OR after failure of at least one antiarrhythmic drug — the 2024 guidelines upgraded ablation from a second-line to a first-line option
Answer D is correct. Catheter ablation is no longer treated as a remote ‘last resort’ for symptomatic AF. In the 2024 ESC AF pathway, it is an established rhythm-control option: it is recommended after failure, intolerance or unsuitability of at least one antiarrhythmic drug in symptomatic paroxysmal or persistent AF, and it may also be used earlier as first-line rhythm control in selected patients, especially paroxysmal AF. This 55-year-old has symptomatic persistent AF and has already failed two antiarrhythmic drugs, so he clearly meets the threshold for catheter ablation. The distractors are wrong because ablation is not removed from the algorithm, is not limited to paroxysmal AF, and does not require failure of all possible drug options.
Reference: European Society of Cardiology. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. European Heart Journal 2024;45:3314-3414. https://academic.oup.com/eurheartj/article/45/36/3314/7738779