Pacing, ICD, or Both for the Hybrid Therapy of Atrial Arrhythmias?
Atrial fibrillation (AF) is the most common cardiac arrhythmia, and its prevalence is expected to increase further in the coming years W. The treatment of recurrent paroxysmal AF is frustrating in clinical practice, due to the high rate of recurrences and the lack of uniformly effective treatments [2-4]. Antiarrhythmic drugs are classically the first approach to preventing AF recurrences, but no more than 50% of patients respond to drug therapy within 1 year [2-4]. In view of this limited efficacy and the risk of proarrhythmia, especially in patients with left ventricular dysfunction, new, nonpharmacological treatments for AF are being developed [5,6]. These treatments may be classified as: rescue (catheter-based atrial cardioversion), curative (focal ablation), suppressive (atrial pacing algorithms), and palliative (ablate and pace strategy). No definite algorithms for choosing the most appropriate treatment in the individual patient have been developed. The therapeutic approach for patients with AF remains clinical and is primarily guided by the clinical presentation of the AF. A series of important questions regarding nonpharmacological treatments are still open; they relate to the selection of candidates for any of these treatments or particular combinations of treatments, the true efficacy, the patient acceptance, the risk-benefit and cost-benefit ratios, and the related social costs.
KeywordsAtrial Fibrillation Atrial Pace Sick Sinus Syndrome Atrial Tachyarrhythmia Atrial Fibrillation Episode
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