Control of Rapid Heart Rate in Patients with Atrial Fibrillation: Drugs or Ablation?
Atrial fibrillation is by far the most frequent arrhythmia. It is particularly frequent in the elderly, in males, and in patients with heart disease. The prevalence of atrial fibrillation is 9.1% in men and women with cardiovascular disease (1). Data from the Framingham study (2) indicate that the overall incidence of developing atrial fibrillation was 529 new cases per year per 100 000 inhabitants aged 50–79 years (250 and 279 for paroxysmal and chronic forms, respectively). Given this high incidence, even if catheter ablation therapy were prescribed for a minority of drug-refractory patients, the total number of potential candidates for this treatment would be high. For example, during 1994 in our institutions radiofrequency catheter ablation of the atrioventricular junction and subsequent pacemaker implantation were performed in 6.4 patients per 100.000 inhabitants; that was only 1.2% of the patients with a new atrial fibrillation, but 18% of the total number of pacemakers implanted during the same period in that population. For comparison, it should be noted that the annual incidence of a new case of Wolff-Parkinson-White syndrome is 4 persons per 100 000 inhabitants (3), about one third of whom may perhaps benefit from radiofrequency therapy.
KeywordsAtrial Fibrillation Sinus Rhythm Catheter Ablation Paroxysmal Atrial Fibrillation Ventricular Rate
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