New advances in nonpharmacologic therapy for atrial fibrillation

Atrial fibrillation (AF) is the most commonly occurring cardiac arrhythmia. Due to the low clinical efficacy of current antiarrhythmic agents, various nonpharmacologic approaches including catheter ablation, permanent cardiac pacing and surgical procedure, alone or in combination, have been developed for the treatment of AF. Except in patients who require open heart surgery, surgical procedures have a very limited role in the treatment of AF. Pacing therapy alone, except in patients with concomitant bradycardia, has a very limited role for the treatment of AF. The incremental benefit of alternate- or multiple-site pacing and different pacing algorithms remains to be defined. Catheter ablation procedures may prove to provide curative therapy for AF in selected but widening patient populations. However, issues concerning the optimal ablation technique and safety of the procedure remain to be resolved. Currently, most of the nonpharmacologic methods of AF treatment are more or less experimental and need to be proven by randomized, control trials before they can be considered as routine therapy for AF.