New concepts in atrial defibrillation

External cardioversion of atrial fibrillation (AF) is an established and ac cepted method for termination of individual episodes of AF. Recent advances have taken place in the area of non-pharmacologic management of AF, and de spite its long history and well established technique, defibrillation has n ot been spared from these advances. The success of low-energy internal atri al defibrillation for the termination of both chronic and acute onset has r esulted in the development of implantable defibrillators that treat this ar rhythmia. Many of the advances have come about as a result of the use of de fibrillation in implanted devices for recurrent AF due to the substantial e fforts in an attempt to make this form of restoration of sinus rhythm more efficacious and tolerable to the patient. Additionally, the use of other non-pharmacologic control of atrial fibrilla tion has also been recently explored, namely the use of ablation and atrial pacing. The use of these other non-pharmacologic therapies are likely to b oth reduce the recurrence rate, as well as enhance the efficacy of defibril lation. However, defibrillation is likely to still be needed to terminate a trial fibrillation for persistent episodes, and its combination with these other therapies is likely synergistic. Electrical therapy to restore sinus rhythm for persistent episodes of AF is likely to be perceived by the patient. Therefore, the concept of patient c ontrolled therapy from implanted devices to treat AF has shown promising re sults and will likely be a requirement of such devices in the future. Major advances in defibrillation therapy for atrial fibrillation have been made and have resulted in the development of implantable atrial defibrillat ors. Despite these advances in defibrillation and other therapies for AF, i t is likely that combined pharmacologic and non-pharmacologic therapies for AF will prevail over the individual entities themselves. Future study is n eeded to determine the best therapy or combination of therapies for individ ual patients with AF.