The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on percutaneous (non-thoracoscopic) epicardial catheter radiofrequency ablation for atrial fibrillation.


Atrial fibrillation is a condition that affects the heart, causing an irregular heartbeat. It increases the risk of blood clots in the heart and stroke. Electrical impulses (originating from the atria, the small chambers of the heart) control the heartbeat. In atrial fibrillation these impulses become disorganised, so that the heart beats irregularly and too quickly. When this happens, the heart cannot efficiently pump blood around the body. This may cause symptoms such as palpitations, chest pain, shortness of breath, dizziness and fainting. In percutaneous (non-thoracoscopic) epicardial catheter radiofrequency ablation, selected areas of the heart are destroyed using heat, with the aim of preventing the abnormal electrical impulses responsible for atrial fibrillation. The procedure is carried out through a special catheter which is inserted into the lower chest area and guided to the outer part of the heart.

Coding recommendations

K64.1 Percutaneous radiofrequency ablation of epicardium

Y53.4 Approach to organ under fluoroscopic control

In addition the ICD-10 code I48.X Atrial fibrillation and flutter would be recorded.

Your responsibility

This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer. 

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

  • National Institute for Health and Care Excellence (NICE)