creators_name: Anfinsen, Ole-Gunnar editors_name: Singh, Balbir editors_name: Lokhandwala, Yash editors_name: Francis, Johnson editors_name: Gupta, Anup type: journalp datestamp: 2005-05-02 lastmod: 2011-03-11 08:56:02 metadata_visibility: show title: Non-pharmacological Treatment of Atrial Fibrillation ispublished: pub subjects: ipej full_text_status: public keywords: Non-pharmacological Treatment; Atrial Fibrillation abstract: In selected patients with atrial fibrillation and severe symptoms, non-pharmacological treatment may be an alternative or supplement to drug therapy. Atrioventricular nodal radiofrequency ablation (requires pacemaker implantation), or atrial pacing for sick sinus syndrome, are established treatment modalities. All other non-pharmacological therapies for atrial fibrillation are still experimental. After the Maze operation, atrial depolarization has to follow one specific path determined by surgical scars in the myocardium. This prevents new episodes of atrial fibrillation, but at a cost of perioperative morbidity and mortality. Catheter-based “Maze-like” radiofrequency ablation is technically difficult, and thrombo-embolic complications may occur. Paroxysmal atrial fibrillation sometimes is initiated by spontaneous depolarizations in a pulmonary vein inlet. Radio frequency ablation against such focal activity has been reported with high therapeutic success, but the results await confirmation from several centres. For ventricular rate control, most electrophysiologists present­ly prefer ablation to induce a complete atrioventricular conduction block (with pacemaker) rather than trying to modify conduction by incomplete block. Atrial or dual chamber pacing may prevent atrial fibrillation induced by bradycardia. It remains to confirm that biatrial or multisite right atrial pacing prevents atrial fibrillation more efficiently than ordinary right atrial pacing. An atrial defibrillator is able to diagnose and convert atrial fibrillation. The equipment is expensive, and therapy without sedation may be unpleasant beyond tolerability. date: 2002-01 date_type: published publication: Indian Pacing and Electrophysiology Journal volume: 2 number: 1 publisher: Indian Pacing and Electrophysiology Group pagerange: 4-14 refereed: TRUE referencetext: 1. Olsson SB. Atrial fibrillation – epidemiological and electrophysiological aspects. Tidsskr Nor La egeforen 1999; 119: 1601-4. Medline 2. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham study. Stroke 1991; 22: 983-8. Medline 3. Levy S, Breithardt G, Campbell RW, Camm AJ, Daubert JC, Allessie M et al. Atrial fibrillation: current knowledge and recommendations for management. Working Group on Arrhythmias of the European Society of Cardiology. Eur Heart J 1998; 19: 1294-320. 4. Kannel WB, Abbott RD, Savage DD, McNamara PM. 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