Pacing for atrial fibrillation

Open Access
Publisher Website
Google Scholar
Abstract
Conventional pharmacological treatments includes rate control with AV nodal blockers, maintenance of sinus rhythm, and anticoagulation. While rate control and anticoagulation is a recognised treatment strategy, proarrhythmia using class I antiarrhythmic agents to maintain sinus rhythm remains a concern. A recent study1 has shown that low dose amiodarone, when compared to either sotalol or propafenone, is more efficacious in maintaining sinus rhythm. However, amiodarone had to be discontinued for cardiac and non-cardiac side effects in 18% of patients, while 35% of patients still developed AF at 16 months. While newer antiarrhythmic agents may enhance our success in these refractory cases, the current experience underscores the difficulties of long term pharmacological treatment to maintain sinus rhythm. Indeed, the preliminary results of the AFFIRM (atrial fibrillation following investigation of rhythm management) trial did not show the superiority of rhythm maintenance using drugs over rate control alone (late breaking news, American College of Cardiology annual meeting, 2002). Thus, the use of pacing, either alone or in a hybrid fashion with other treatments, has recently gained favour for treating AF.