The place of hybrid therapies with drugs to supplement nonpharmacological therapies in atrial fibrillation.
Atrial fibrillation (AF) is one of the most common cardiac arrhythmias, and its prevalence continues to rise as the aged population increases. Comparative studies of rhythm control and rate control have been equivocal; however, the benefits of rhythm control may have been offset by the limitations of antiarrhythmic drugs. More recently, nonpharmacological therapies have emerged that provide hope of more effective rhythm control. Catheter ablation techniques have gained favour with high success rates in specialized centers, although these techniques are not without complications and require considerable expertise. Pacing therapies designed to reduce harmful right ventricular pacing and increase physiological pacing have shown benefit in AF patients with bradycardia. Despite this progress, no single modality confers benefit for all patients. Strategies to combine these treatment modalities in a hybrid approach has shown increasing promise for subgroups of AF patients.
Govindan
Malini
M
Division of Cardiac and Vascular Sciences, St Georges Hospital University of London, London, UK. m.govindan@sgul.ac.uk
Catanchin
Andrei
A
Camm
A John
AJ
D000889:Anti-Arrhythmia Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D001919:Bradycardia / Q000150:complications / Q000628:therapy; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods; D006801:Humans
D000889:Anti-Arrhythmia Agents