Electrical Therapy of Atrial Fibrillation
Journal of Clinical and Basic Cardiology 2001; 4 (2): 123-129
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Keywords: Elektrotherapie, Vorhofflimmern, atrial fibrillation, electrical therapy
The limitations of pharmacological therapy have led to novel electrical approaches for treatment of atrial fibrillation, including pacing, ablation and atrial defibrillation. The choice of these approaches mostly depends on the type of atrial fibrillation and specific patient subpopulation. Atrial pacing is indicated in sick sinus syndrome, because it reduces development of chronic atrial fibrillation in this subpopulation of patients. Both dual atrial and biatrial pacing may be used in selected patients with resistant atrial fibrillation, especially if they have significant intra-atrial conduction delays. The atrioventricular (AV) nodal ablation or modification should be reserved for patients in whom complete AV block and pacemaker implantation are an acceptable treatment. In selected patients, the AV nodal ablation is more effective than modification in improving quality of life and cardiac performance. The creation of linear ablation lesions in the right and/or left atrium for disabling of intra-atrial reentry, or ablation of atrial foci, seems a very promising therapeutic approach, but it is still in the phase of investigation. The atrial defibrillator is being shown to be safe and efficacious for converting atrial fibrillation to sinus rhythm. The major issue that still should be resolved is the pain perception during shock therapy and selection of adequate patients. Since it is not likely that one therapeutic modality will adequately treat the majority of atrial fibrillation, it is reasonable to presume that the synergistic therapy of different approaches will offer the optimal care to patients in the future.