Hybrid Therapy of Atrial Fibrillation: Algorithms and Outcome

Article

DOI: 10.1023/A:1026296710161

Cite this article as:
Saksena, S. & Madan, N. J Interv Card Electrophysiol (2003) 9: 235. doi:10.1023/A:1026296710161

Abstract

Rhythm control methods have not shown superior outcomes to rate control strategies in atrial fibrillation. Newer approaches to rhythm control employ “hybrid” therapies combining pharmacologic and non pharmacologic interventions. Pathophysiologic insights into mechanisms of atrial fibrillation (AF) suggest that arrhythmogenesis is due to interactions of multiple triggering rhythms and a complex electrophysiologic substrate resulting in the emergence of multiple tachyarrhythmias, often in disparate locations that may coexist in time. Thus, an “hybrid” therapy prescription is more likely to address several of the etiologic factors culminating in clinical AF. Results of pilot clinical studies of hybrid therapy are encouraging and involve drugs, devices and ablation techniques in varying permutations. Hybrid therapy algorithms using right heart procedures can improve efficacy with potentially lower risk. Considerations in implementation of these algorithms include staged or simultaneous interventions and a right versus left heart strategy. The parallel with the current coronary disease management paradigm is obvious and relevant.

atrial fibrillationantiarrhythmic drugscatheter ablationpacemakersdefibrillators

Copyright information

© Kluwer Academic Publishers 2003

Authors and Affiliations

  1. 1.Arrhythmia and Pacemaker Service, Cardiovascular Institute, Atlantic Health System, Passaic, NJ, USA; Department of MedicineUniversity of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical SchoolNew BrunswickUSA