Recent advances in the non-surgical management of atrial fibrillation

Atrial fibrillation is the commonest clinical arrhythmia, and is associated with significant morbidity and mortality The treatment of choice is to res tore and maintain sinus rhythm. Although certain antiarrhythmic drugs are m ore effective than placebo in maintaining sinus rhythm, recurrence of atria l fibrillation post cardioversion remains common. The use of antiarrhythmic drugs can be associated with serious adverse effects due to their negative inotropic and proarrhythmic effects. Radiofrequency ablation of the AV jun ction is a safe and effective palliative treatment option in patients who h ave failed drug therapy. Ventricular rate control without the need for perm anent pacing can be achieved by AV nodal modification using radiofrequency energy. There is also interest in the role of catheter ablation as a possib le curative procedure for atrial fibrillation, Atrial pacing can reduce the incidence of atrial fibrillation in certain subgroups of patients. Finally , low energy intracardiac atrial defibrillation has been shown to be feasib le in humans.