Transcatheter radiofrequency ablation (RFA) or cryoablation to treat atrial fibrillation may be considered medically necessary as a treatment for either of the following indications, which have failed to respond to adequate trials of antiarrhythmic medications:
Symptomatic paroxysmal or symptomatic persistent atrial fibrillation; or
As an alternative to atrioventricular nodal ablation and pacemaker insertion in individuals with class II or III congestive heart failure and symptomatic atrial fibrillation.
Transcatheter RFA or cryoablation to treat atrial fibrillation may be considered medically necessary as an initial treatment for individuals with recurrent symptomatic paroxysmal atrial fibrillation (>1 episode, with ≤4 episodes in the previous 6 months) in whom a rhythm-control strategy is desired.
Repeat RFA or cryoablation may be considered medically necessary in individuals with recurrence of atrial fibrillation and/or development of atrial flutter following the initial procedure (see Policy Guidelines section).
Transcatheter RFA or cryoablation to treat atrial fibrillation is considered investigational as a treatment for cases of atrial fibrillation that do not meet the criteria outlined above.
