1.1 There is evidence of efficacy for thoracoscopic epicardial radiofrequency ablation for atrial fibrillation (AF) in the short term and in small numbers of patients. The assessment of cardiac rhythm during follow-up varied between studies, and some patients were concomitantly treated with anti-arrhythmic medication. Evidence on safety shows a low incidence of serious complications but this is also based on a limited number of patients. Therefore the procedure should only be used with special arrangements for clinical governance, consent and audit or research.
1.2 Clinicians wishing to undertake thoracoscopic epicardial 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 patients ('Understanding NICE guidance') is recommended.
1.3 Patient selection for thoracoscopic epicardial radiofrequency ablation for AF should involve a multidisciplinary team including a cardiologist and a cardiac surgeon, both with training and experience in the use of intraoperative electrophysiology.
1.4 The procedure should only be carried out by surgeons with specific training and experience in both thoracoscopic surgery and radiofrequency ablation.
1.5 The NHS Information Centre for Health and Social Care runs the UK Central Cardiac Audit Database (CCAD), and is developing a database for this procedure. Clinicians should collect data on the procedure and submit them to the database when it becomes available.
1.6 NICE encourages further comparative research into the treatment and management of AF, with clearly defined outcomes. NICE may review this procedure on publication of further evidence.