Non-pharmacological, non-ablative approaches for the treatment of atrial fibrillation: experimental evidence and potential clinical implications.
In this review, we initially covered the basic and clinical reports that provided the prevalent concepts underlying the mechanisms for atrial fibrillation (AF). The clinical evolution of catheter ablation and its eventual application to AF has also been detailed. A critique of the results based on a review of the literature has shown that either or both drugs or catheter ablation therapy for preventing AF recurrences have significant limitations and even serious complications. Finally, we have presented recent experimental studies which suggest that an alternative approach to reducing AF inducibility can be achieved with low-level autonomic nerve stimulation. Specifically, electrical stimulation of the vago-sympathetic trunks, at levels well below that which slows the heart rate can significantly increase AF thresholds and suppress AF inducibility. Further studies will determine if this new method can be used as an effective means of treating some forms of clinical AF.
Heart Rhythm Institute, University of Oklahoma Health Sciences Center, 1200 Everett Drive, Rm 6E103, Oklahoma City, OK 73104, USA. benjamin-scherlag@ouhsc.edu
Benjamin J
BJ
Scherlag
Hiroshi
H
Nakagawa
Warren M
WM
Jackman
Ralph
R
Lazzara
Sunny S
SS
Po
D000818:Animals; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000628:therapy*; D001341:Autonomic Nervous System / Q000503:physiopathology*; D006328:Cardiac Catheterization; D006321:Heart / Q000294:innervation*; D006339:Heart Rate; D006801:Humans; D016896:Treatment Outcome; D055536:Vagus Nerve Stimulation
D000889:Anti-Arrhythmia Agents