FUTURE-DIRECTIONS OF ELECTROTHERAPY FOR ATRIAL-FIBRILLATION

Electrotherapy for Atrial Fibrillation. Suboptimal treatment of atrial fibrillation (AF) by pharmacotherapy alone has given rise to multiple novel electrotherapeutic modalities including pacing, ablation, and a trial defibrillation, These treatment approaches offer physicians the opportunity to evaluate their patients more extensively to better opti mize therapy. AV junctional node ablation followed by full-time pacing improves quality of life and reduces the incidence of tachycardia-ind uced cardiomyopathy, physicians who are reluctant to ablate the AV nod e may opt for either an AV nodal modification procedure or therapeutic modalities that attempt to maintain sinus rhythm. Both biatrial and d ual site pacing have met with some success in preventing AF in a limit ed patient population. Studies also have evaluated the extent to which pacing may be used to terminate AF. These initial studies showed that , in general, pacing was ineffective. Radiofrequency catheter ablation is another therapeutic modality receiving considerable interest. The creation of multiple lesions mimicking the maze procedure, isthmus abl ation to prevent the onset of atrial flutter that may degrade into AF, and ablation of tachycardia foci are all potential treatment alternat ives to consider either as the primary therapy or as a synergistic pro cedure designed to augment another electrical therapy, Internal atrial defibrillation is being shown to be both safe and efficacious, This t herapy appears uniquely able to repeatedly restore sinus rhythm in a s egment of the AF population. Any of these therapies, either alone or m ore likely in some form of combined therapy, is likely to significantl y influence and improve the care of patients with AF in the future.