HYBRID PHARMACOLOGICAL AND ABLATIVE THERAPY - A NOVEL AND EFFECTIVE APPROACH FOR THE MANAGEMENT OF ATRIAL-FIBRILLATION

Hybrid Therapy for Atrial Fibrillation, Introduction: Maintenance of s inus rhythm in patients with recurrent atrial fibrillation is often di fficult to achieve with pharmacologic therapy. Complex catheter ablati ve procedures are being developed, but efficacy and safety issues rema in to be clarified. We hypothesized that combined pharmacologic and si mple ablative therapies in a targeted subset of patients will improve success in the treatment of atrial fibrillation.Methods and Results: W e identified 13 patients (mean age 61.5 +/- 16.2 Sears) with atrial fi brillation who converted to electrocardiographic atrial nutter during antiarrhythmic drug treatment. Surface ECG suggested ''typical'' atria l nutter in 11 patients and ''atypical'' atrial nutter in 2. Intracard iac mapping and entraimment studies revealed 9 patients had counterclo ckwise isthmus-dependent atrial nutter, and the remaining 4 had comple x activation patterns, suggesting the presence of multiple wavefronts. All 9 patients with typical atrial nutter underwent successful ablati on. None of the 4 patients with complex activation patterns had succes sful ablation. Patients were followed for recurrences of atrial arrhyt hmias via clinic visits, record review, and interviews. In patients wh o underwent successful ablation and continued on antiarrhythmic drugs, 88.9% remain in sinus rhythm after a mean follow-up of 14.3 +/- 6.9 m onths (range 1 to 28). Conclusion: In patients who experience conversi on of atrial fibrillation to atrial nutter during antiarrhythmic drug treatment, ablation and continuation of pharmacologic therapy is a saf e and effective means of achieving and maintaining sinus rhythm.