Nonpharmacologic strategies for treating atrial fibrillation

The American Journal of Cardiology
B LüderitzW Jung

Abstract

Nonpharmacologic tools to treat atrial fibrillation (AF) are direct current cardioversion, radiofrequency (RF) current catheter ablation, antiarrhythmic surgery, pacing, and atrial defibrillation. In patients with sustained AF, when no cause can be found for AF or when the associated disease is mild, an attempt should be made to restore sinus rhythm. Electrical cardioversion by synchronized direct current shock can be attempted when drugs have failed and is the first choice in acutely ill patients. Virtually all patients should be anticoagulated. Temporary pacing should be available in patients with evidence of previous bradycardia. Although efficacy may be improved in patients pretreated with antiarrhythmic drugs, there is a considerable risk of adverse events. In AF and sinus node dysfunction, both pacing and antiarrhythmic drugs may be necessary. Pacing should be atrial or dual chamber, since ventricular pacing provokes AF. Failure to control the ventricular rate in AF can be treated by RF: atrioventricular (AV) node ablation, ablation of accessory pathways in preexcitation syndrome with AF, modulation of AV node, or ablation of AF. Antiarrhythmic surgery is a major procedure and may be the therapy of last resort in AF: the ...Continue Reading

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Citations

Oct 6, 1997·Pacing and Clinical Electrophysiology : PACE·W Jung, B Lüderitz
May 19, 1998·Pacing and Clinical Electrophysiology : PACE·C CosteasJ A Reiffel
May 19, 1998·Pacing and Clinical Electrophysiology : PACE·F J ChorroV López-Merino
Jun 22, 2000·Medical Hypotheses·J L Kavanau
Jun 17, 1999·The New England Journal of Medicine·H OralF Morady
Sep 25, 2002·Clinical Cardiology·Mithilesh Kumar DasMajesh Makan
Jul 1, 1997·Clinical Cardiology·L L Mackstaller, J S Alpert
May 20, 2000·Clinical Orthopaedics and Related Research·M J LopezM D Markel
Aug 5, 1998·Herz·W Jung, B Lüderitz
Jul 7, 1999·Neuroscience and Biobehavioral Reviews·J L Kavanau

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