Potential role of 'hybrid therapy' for atrial fibrillation.
Atrial fibrillation is the most common sustained arrhythmia in clinical practice. Several new non-pharmacological technologies are emerging which may offer hope for effective therapy and quality of life improvement of patients with atrial fibrillation. While both catheter-based atrial segmentation and implanted atrial defibrillators have the potential to revolutionize the treatment of patients with atrial fibrillation, both are also associated with the potential for significant limitations. Catheter ablation with the goal of curing atrial fibrillation may be a lengthy procedure and if left atrial lesions are required there is the potential for complications. As regards implanted atrial defibrillators an important question is whether many patients will tolerate the discomfort associated with energy levels required to restore sinus rhythm. The concept of 'hybrid therapy' is that in a given patient a combination of modalities might be used so as to achieve a synergistic effect, with each technology improving the efficacy of the other. For example, the presence of a more 'organized' pattern of fibrillation implies a lower defibrillation threshold. Data in a canine model of atrial fibrillation suggests that linear lesions in the right atrium alone may organize the atrial fibrillation in both atria and in so doing lower the atrial defibrillation threshold. Hybrid therapy may also employ drugs and pacing in combination with ablative lesions and an implanted atrial defibrillator.
Lesh
M D
MD
Department of Medicine, University of California, San Francisco, USA. lesh.ep4.ucsf.edu
Kalman
J M
JM
Roithinger
F X
FX
Karch
M R
MR
D000818:Animals; D001281:Atrial Fibrillation / Q000628:therapy*; D002304:Cardiac Pacing, Artificial; D017115:Catheter Ablation; D017147:Defibrillators, Implantable; D004285:Dogs; D006801:Humans; D016896:Treatment Outcome