Intra-Atrial Defibrillation in Humans

The frequency of atrial fibrillation (AF) and its economic impact on the health-care system ensure that AF will be a focus for future research. At present, the chronic use of an atrioverter (IAD) is a major challenge in the nonpharmacological treatment of AF. Studies in animals as well as in humans have demonstrated the feasibility and safety of internal atrial defibrillation. The major issues that have to be addressed are the pain perception and the potential risk of inducing life-threatening ventricular arrhythmias during delivery of low-energy atrial shocks. A first step to this novel approach is a physician activated device. At the very beginning, the IAD should be restricted to highly selected patients with drug refractory, poorly tolerated, recurrent AF episodes. The extenuation of this therapy to wider subsets of patients should be dependent on the initial results with regard to clinical efficacy and safety as well as patient tolerance. Finally, cost-effectiveness as well as quality of life studies are needed to demonstrate the benefit of this specific therapy among other therapeutic strategies available for the management of AF. A new arrhythmia management system that combines both detection and treatment in the atrium as well as in the ventricle may represent an important milestone and a significant improvement in the management of patients with both supraventricular and ventricular tachyarrhythmias.