Future role of electrical therapy for atrial fibrillation: reality for all?
St. George's Hospital Medical School, London, U.K.
* Correspondence: Professor A. John Camm, Professor of Clinical Cardiology, Department of Cardiological Sciences, St. George's Hospital Medical School, Cranmer Terrace, London, SW17 ORE, U.K.
Abstract
Atrial fibrillation (AF) is a highly prevalent condition with a rapidly growing incidence, especially in elderly patients with underlying heart disease. The arrhythmia can be treated by a vast array of pharmaceutical and non-pharmacological therapies, suggesting that no single treatment is sufficiently simple, successful and cheap to exclude other therapies. Many new therapies are presently being developed, among which are electrical therapies that are designed to prevent and convert AF. Cardiac pacemakers, implantable atrial defibrillators and ablation techniques to modify the behaviour of the atrial myocardium are discussed in this symposium. Some of the specific techniques have been shown to be valuable in case reports, small case-matched series and small randomized clinical trials. The technology associated with these techniques is still in a developmental stage, however, and cannot yet be widely assessed from a practical clinical perspective. Extensive clinical implementation will require demonstration of clinical efficacy, feasibility and cost-benefit before it is possible to argue for the increased resources that will be necessary to fund widespread use of electrical treatments for the management of AF.
Key Words: Atrial defibrillator • pacemaker