Non-pharmacological Treatment of Atrial Fibrillation

Anfinsen, Ole-Gunnar (2002) Non-pharmacological Treatment of Atrial Fibrillation. [Journal (Paginated)]

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In selected patients with atrial fibrillation and severe symptoms, non-pharmacological treatment may be an alternative or supplement to drug therapy. Atrioventricular nodal radiofrequency ablation (requires pacemaker implantation), or atrial pacing for sick sinus syndrome, are established treatment modalities. All other non-pharmacological therapies for atrial fibrillation are still experimental. After the Maze operation, atrial depolarization has to follow one specific path determined by surgical scars in the myocardium. This prevents new episodes of atrial fibrillation, but at a cost of perioperative morbidity and mortality. Catheter-based “Maze-like” radiofrequency ablation is technically difficult, and thrombo-embolic complications may occur. Paroxysmal atrial fibrillation sometimes is initiated by spontaneous depolarizations in a pulmonary vein inlet. Radio frequency ablation against such focal activity has been reported with high therapeutic success, but the results await confirmation from several centres. For ventricular rate control, most electrophysiologists present­ly prefer ablation to induce a complete atrioventricular conduction block (with pacemaker) rather than trying to modify conduction by incomplete block. Atrial or dual chamber pacing may prevent atrial fibrillation induced by bradycardia. It remains to confirm that biatrial or multisite right atrial pacing prevents atrial fibrillation more efficiently than ordinary right atrial pacing. An atrial defibrillator is able to diagnose and convert atrial fibrillation. The equipment is expensive, and therapy without sedation may be unpleasant beyond tolerability.

Item Type:Journal (Paginated)
Keywords:Non-pharmacological Treatment; Atrial Fibrillation
Subjects:JOURNALS > Indian Pacing and Electrophysiology Journal
ID Code:4319
Deposited By: Indian Pacing and Electrophysiology, Journal
Deposited On:02 May 2005
Last Modified:11 Mar 2011 08:56

References in Article

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1. Olsson SB. Atrial fibrillation – epidemiological and electrophysiological aspects. Tidsskr Nor La egeforen 1999; 119: 1601-4. Medline

2. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham study. Stroke 1991; 22: 983-8. Medline

3. Levy S, Breithardt G, Campbell RW, Camm AJ, Daubert JC, Allessie M et al. Atrial fibrillation: current knowledge and recommendations for management. Working Group on Arrhythmias of the European Society of Cardiology. Eur Heart J 1998; 19: 1294-320.

4. Kannel WB, Abbott RD, Savage DD, McNamara PM. Epidemiologic features of chronic atrial fibrillation: the Framingham study. N Engl J Med 1982; 306: 1018-22. Medline

5. Kopecky SL, Gersh BJ, McGoon MD, Whisnant JP, Holmes DR jr. et al. The natural history of lone atrial fibrillation. A population-based study over three decades. N Engl J Med 1987; 317: 669-74. Medline

6. Moe GK. On the multiple wavelet hypothesis of atrial fibrillation. Arch Int Pharmacodyn Ther 1962; 140: 183-8.

7. Allessie M. Zipes DP, Jalife J. Cardiac electrophysiology: from cell to bedside. Philadelphia: W.B. Saunders 1995; 53: 562-6.

8. Wijffels MC, Kirchhof CJ, Dorland R, Allessie MA. Atrial fibrillation begets atrial fibrillation. A study in awake chronically instrumented goats. Circulation 1995; 92: 1954-68. Medline

9. Haissaguerre M, Jais P, Shah DC, Takahashi A, Hocini M, Quiniou G et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 1998; 339: 659-66. Medline

10. Jalife J, Berenfeld O, Skanes A, Mandapati R. Mechanisms of atrial fibrillation: mother rotors or multiple daughter waves, or both? J Cardiovasc Electrophysiol 1998; 9(suppl): 2-12.

11. Lau CP, Tse HF, Ayers GM. Defibrillation-guided radiofrequency ablation of atrial fibrillation secondary to an atrial focus. J Am Coll Cardiol 1999; 33: 1217-26. Medline

12. Petersen P, Boysen G, Godtfredsen J, Andersen ED, Andersen B. Placebo-controlled, randomised trial of warfarin and aspirin for prevention of thromboembolic complications in chronic atrial fibrillation. The Copenhagen AFASAK study. Lancet 1989; 1: 175-9. Medline

13. Warfarin versus aspirin for prevention of thromboembolism in atrial fibrillation: Stroke Prevention in Atrial Fibrillation II Study. Lancet 1994; 343: 687-91. Medline

14. Capucci A, Boriani G, Rubino I, Della Casa S, Sanguinetti M, Magnani B. A controlled study on oral propafenone versus digoxin plus quinidine in converting recent onset atrial fibrillation to sinus rhythm. Int J Cardiol 1994; 43: 305-13. Medline

15. Fresco C, Proclemer A. Clinical challenge. II. Management of recent onset atrial fibrillation. PAFIT-2 Investigators. Eur Heart J 1996; 17: 41-7. Medline

16. Reimold SC. Clinical challenge. I: Control of recurrent symptomatic atrial fibrillation. Eur Heart J 1996; 17: 35-40. Medline

17. Coplen SE, Antman EM, Berlin JA, Hewitt P, Chalmers TC. Efficacy and safety of quinidine therapy for maintenance of sinus rhythm after cardioversion. A meta-analysis of randomized control trials. Circulation 1990; 82: 1106-16. Medline

18. Guiraudon GM, Campbell CS, Jones DL, McLellan DG, MacDonald, JL. Combined sinoatrial node and atrioventricular node isolation. A surgical alternative to His bundle ablation in patients with atrial fibrillation. Circulation 1985; 72(suppl 3): 220.

19. Cox JL, Schuessler RB, Cain ME, Corr PB, Stone CM, D'Agostino HJ jr. et al. Surgery for atrial fibrillation. Semin Thorac Cardiovasc Surg 1989; 1: 67-73. Medline

20. Cox JL. Atrial transport function after the Maze procedure for atrial fibrillation: a 10-year clinical experience. Am Heart J 1998; 136: 934-6. Medline

21. Jackman WM, Wang XZ, Friday KJ, Roman CA, Moulton KP, Beckman KJ et al. Catheter ablation of accessory atrioventricular pathways (Wolff-Parkinson-White syndrome) by radiofrequency current. N Engl J Med 1991; 324: 1605-11. Medline

22. Scheinman MM, Morady F, Hess DS, Gonzalez R. Catheter-induced ablation of the atrioventricular junction to control refractory supraventricular arrhythmias. JAMA 1982; 248: 851-5. Medline

23. Borggrefe M, Rudde T, Podzeck A, Breithardt G. Application of transvenous radio-frequency alternating current ablations in humans. Circulation 1987; 76 (suppl IV): 406.

24. Geelen P, Brugada J, Andries E, Brugada P. Ventricular fibrillation and sudden death after radiofrequency catheter ablation of the atrioventricular junction. PACE 1997; 20: 343-8. Medline

25. Gjesdal K, Platou ES, Aass H, Orning OM. Ablation of the bundle of His. A solution when the drugs fail. Tidsskr Nor Lægeforen 1996; 116: 3222-5. Medline

26. Feld GK, Fleck RP, Fujimura O, Prothro DL, Bahnson TD, Ibarra M. Control of rapid ventricular response by radiofrequency catheter modification of the atrioventricular node in patients with medically refractory atrial fibrillation. Circulation 1994; 90: 2299-307. Medline

27. Proclemer A, Della Bella P, Tondo C, Facchin D, Carbucicchio C, Riva S et al. Radiofrequency ablation of atrioventricular junction and pacemaker implantation versus modulation of atrioventricular conduction in drug refractory atrial fibrillation. Am J Cardiol 1999; 83: 1437-42. Medline

28. Haissaguerre M, Gencel L, Fischer B, Le Metayer P, Poquet F, Marcus FI et al. Successful catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol 1994; 5: 1045-52. Medline

29. Swartz JF, Pellersells G, Silvers J, Patten L, Cervantez D. A catheter-based curative approach to atrial fibrillation in humans. Circulation 1994; 90(suppl I): 335.

30. Lindsay BD, Boineau JP, Schuessler RB, Lappas DG, Cox JL. Intraoperative observations and epicardial mapping after attempted catheter ablation of atrial fibrillation. Circulation 1997; 96(suppl I): 450.

31. Haissaguerre M, Jais P, Shah DC, Gencel L, Pradeau V, Garrigues S et al. Right and left atrial radiofrequency catheter therapy of paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol 1996; 7: 1132-44. Medline

32. Gepstein L, Hayam G, Ben-Haim SA. A novel method for nonfluoroscopic catheter-based electroanatomical mapping of the heart. In vitro and in vivo accuracy results. Circulation 1997; 95: 1611-22. Medline

33. Schilling RJ, Peters NS, Kadish A, Davies DW. Characterisation of human atrial flutter using a novel non-contact mapping system. Eur Heart J 1997; 18(suppl I): 207.

34. Andersen HR, Thuesen L, Bagger JP, Vesterlund T, Thomsen PE. Prospective randomised trial of atrial versus ventricular pacing in sick-sinus syndrome. Lancet 1994; 344: 1523-8. Medline

35. Andersen HR, Nielsen JC, Thomsen PE, Thuesen L, Mortensen PT, Vesterlund T et al. Long-term follow-up of patients from a randomised trial of atrial versus ventricular pacing for sick-sinus syndrome. Lancet 1997; 350: 1210-6. Medline

36. Daubert C, Gras D, Berder V, Leclercq C, Mabo P. Permanent atrial resynchronization by synchronous bi-atrial pacing in the preventive treatment of atrial flutter associated with high degree interatrial block. Arch Mal Coeur Vaiss 1994; 87(suppl): 1535-46.

37. Mabo P, Paul V, Jung W, Clementy J, Bouhour JC, Daubert JC. Biatrial synchronous pacing for atrial arrhtyhmia prevention: The SYNBIAPACE Study. Eur Heart J 1999; 20(suppl): 4.

38. Saksena S, Prakash A, Hill M, Krol RB, Munsif AN, Mathew PP et al. Prevention of recurrent atrial fibrillation with chronic dual-site right atrial pacing. J Am Coll Cardiol 1996; 28: 687-94. Medline

39. Lau CP, Tse HF, Lok NS, Lee KL, Ho DS, Sopher M et al. Initial clinical experience with an implantable human atrial defibrillator. PACE 1997; 20: 220-5. Medline

40. Wellens HJ, Lau CP, Luderitz B, Akhtar M, Waldo AL, Camm AJ et al. Atrioverter: an implantable device for the treatment of atrial fibrillation. Circulation 1998; 98: 1651-6. Medline

41. Timmermans C, Wellens HJ. Effect of device-mediated therapy on symptomatic episodes of atrial fibrillation. J Am Coll Cardiol 1998; 31(suppl A): 331.

42. Cox JL. Evolving applications of the Maze procedure for atrial fibrillation. Ann Thorac Surg 1993; 55: 578-80.


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