Abstract
Radiofrequency catheter ablation (RFCA) has been established as a curative alternative to antiarrhythmic drug (AAD) therapy in patients with supraventricular arrhythmias other than atrial fibrillation (AF). Many currently used AAD have limited efficacy and cause cardiac and extracardiac adverse effects. There is a need for new AADs with high efficacy and a favorable safety profile in AF patients. Dronedarone and vernakalant are promising new agents with a low risk profile up to date. Effectively restoring sinus rhythm is a crucial aspect in heart failure (HF) patients with AF. RFCA, including pulmonary vein isolation and other left and right atrial ablation targets, offers the possibility of long-term suppressive or curative therapy of AF. New antiarrhythmic drug and interventional concepts in AF and HF patients are discussed.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Wyse DG, Waldo AL, Di Marco JP, Domanski MJ, Rosenberg Y, Schron EB et al (2002) Atrial fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) investigators. A comparison of rate and rhythm control in patients with atrial fibrillation. N Engl J Med 347:1825–1833
Van Gelder IC, Hagens VE, Boskar HA, Kingma JH, Kamp O, Kingma T et al (2002) Rate control versus electrical cardioversion for persistent atrial fibrillation study group. A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation. N Engl J Med 347:1834–1840
Hohnloser SH, Kuck KH, Lilienthal J et al (2000) Rhythm or rate control in atrial fibrillation—Pharmacological intervention in atrial fibrillation (PIAF): a randomized trial. Lancet 356:1789–1794
Roy D, Talajic M, Nattel S, Wyse DG, Doria P, Lee KL et al (2008) Rhythm control versus rate control for atrial fibrillation and heart failure. N Engl J Med 358:2667–2677
Lafuente-Lafuente C, Mouly S, Longas-Tejero MA, Bergmann JF (2006) Antiarrhythmic drugs for maintaining sinus rhythm after cardioversion of atrial fibrillation: a systematic review of randomized controlled trials. Arch Int Med 166(7):719–728
AFFIRM First Antiarrhythmic Sub Study Investigators (2003) Maintenance of sinus rhythm in patients with atrial fibrillation: an AFFIRM sub study of the first antiarrhythmic drug. J Am Coll Cardiol 42:20–29
Benjamin EJ, Levy D, Vaziri SM, Dàgostino RB, Belanger AJ, Wolf PA (1994) Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study. J Am Med Assoc 271:840–844
Grönefeld GC, Hohnloser SH (2003) Heart failure complicated by atrial fibrillation: mechanistic, prognostic, and therapeutical implications. J Cardiovasc Pharmacol Ther 8(2):107–113
Wegener FT, Ehrlich JR, Hohnloser SH (2006) Dronedarone: an emerging agent with rhythm- and rate-controlling effects. J Cardiovasc Electrophysiol 17(Suppl 2):17–20
Sun SM, Sarma JSN, Singh BN (2002) Chronic and acute effects of dronedarone on the action potential of atrial rabbit muscle: comparisons with amiodarone. J Cardiovasc Pharmacol 39:677–684
Singh BN, Conolly SJ, Crijns HF, Roy D, Kowey PR, Capucci A et al (2007) Dronedarone for maintenance of sinus rhythm in atrial fibrillation or flutter. N Engl J Med 357:987–999
Kober L, Torp-Petersen C, Mc Murray JJ, Gotzsche O, Levy S, Crijns H et al (2008) Increased mortality after dronedarone therapy for severe heart failure. N Engl J Med 358:2678–2687
Chen MS, Marrouche NF, Khaykin Y, Gillinov AM, Wazni O, Martin DO et al (2004) Pulmonary vein isolation for the treatment of atrial fibrillation in patients with impaired systolic function. J Am Coll Cardiol 43:1004–1009
Piccini JP, Hasselblad V, Peterson ED, Washam JB, Califf RM, Kong DF (2009) Comparative efficacy of dronedarone and amiodarone for the maintenance of sinus rhythm in patients with atrial fibrillation. J Am Coll Cardiol 54:1089–1095
Roy D, Pratt CM, Torp-Pederson C, Wyse DG, Toft E, Juul-Moller S et al (2008) Vernalakant hydrochloride for rapid conversion of atrial fibrillation: a phase 3, randomized, placebo-controlled trial. Circulation 117:1518–1525
Lutomsky BA, Rostock T, Koops A, Steven D, Mullerleile K, Servatius H et al (2008) Catheter ablation of paroxysmal atrial fibrillation improves cardiac function: a prosepctive study on the impact of atrial fibrillation on left ventricular function assessed by magnetic resonance imaging. Europace 10:593–599
Hsu LF, Jais P, Prashanthan S, Garrique S, Hocini M, Sacher F et al (2004) Catheter ablation for atrial fibrillation in congestive heart failure. N Engl J Med 351:2373–2383
Tondo C, Mantica M, Russo G, Avella A, De Luca L, Pappalardo A et al (2006) Pulmonary vein vestibule ablation for the control of atrial fibrillation in patients with impaired left ventricular function. Pacing Clin Electrophysiol 29:962–970
Marrouche NF, Brachmann J (2009) On behalf of the CASTLE-AF steering committee. Cather ablation versus standard conventional treatment in patients with left ventricular dysfunction and atrial fibrillation (CASTLE-AF)—study design. Pacing Clin Electrophysiol 32:987–994
Oakes RS, Badger TJ, Kholmovski EG, Akoum N, Burgon NS, Fish EN et al (2009) Detection and quantification of left atrial structural remodeling with delayed enhancement magnetic resonance imaging in patients with atrial fibrillation. Circulation 119:1758–1767
McGann CJ, Kholmovski EG, Oakes RS, Blauer JJE, Daccarett M, Segerson N et al (2008) New magnetic resonance imaging-based method for defining the extent of left atrial wall injury after the ablation of atrial fibrillation. J Am Coll Cardiol 52:1263–1271
Conflict of Interest
The author declares that there is no conflict of interest.