Atrial fibrillation in the new millennium--the role of pacemaker and defibrillator therapy

Abstract

Atrial fibrillation is the most common clinical arrhythmia and with an aging population it is becoming an increasing cause of morbidity and hospitalisation. Antiarrhythmic drug therapy unfortunately remains only moderately effective at preventing recurrences of arrhythmia. Attention has now therefore focussed on the development of non-drug techniques to prevent or treat atrial fibrillation in highly symptomatic patients. There are a number of theoretical ways that pacing the atrium may prevent arrhythmias and pacemakers are under investigation for the prevention and termination of atrial arrhythmias with additional tailored, programmable algorithms. The increased memory capacity and diagnostic capabilities of these devices allows the true efficacy of pacemaker interventions to be determined. Early results from studies suggest that the implantation of such pacemakers can reduce atrial fibrillation burden and thereby obviate the need for more invasive procedures such as atrioventricular nodal ablation. The improved diagnostics also provides enhanced information about the onset of atrial arrhythmias and suggests that atrial fibrillation may have periods of high organisation and a window for pace termination. The atrial defibrillator is a useful, but expensive, therapeutic option in patients with recurrent symptomatic persistent atrial fibrillation and the current generation of devices allow patients to activate the device at home using a hand-held activator. This reduces the need for hospitalisation and empowers the patient to 'take charge' of their condition.