14th International Congress
THE "NEW FRONTIERS"
OF ARRHYTHMIAS 2000

Jan. 29 - Feb. 5, 2000
Marilleva, Trento, Italy

S-15

New perspectives in the electrical treatment of atrial fibrillation

Giuseppe Boriani, Mauro Biffi, Claudia Camanini, Ivan Corazza, Romano Zannoli, Angelo Branzi.
Institute of Cardiology, University of Bologna, Bologna, Italy

Introduction

Apart atrial and ventricular ectopic beats, atrial fibrillation is the most frequently occurring cardiac rhythm disturbance. It’s prevalence in the population increases with age: it is 2 to 3 per 1000 between 25 and 35 years, 30 to 40 per 1000 between 50 and 64 years, and 50 to 90 per 1000 between 62 and 90 years¹. In the Framingham study, in a 22 to 30-year follow-up, the incidence of atrial fibrillation was observed increase progressively with age, with a modest male predominance, and overall the change of developing this arrhythmia over two decades was 2%².

The social costs caused by atrial fibrillation are relevant: in the United State atrial fibrillation caused far more hospital admissions than any other arrhythmia, accounting for almost a million days spent in hospital per year³. For the treatment of AF three main goals have to be considered: 1) maintenance of sinus rhythm by preventing AF recurrences, 2) rate control during AF, 3) prevention of AF-related thromboembolic risk. For the first two goals both pharmacological and non pharmacological treatments can be used, alone or in combination. The choice about the most appropriate treatment depends on several factors including arrhythmia characteristics, AF related symptoms, impairment of quality of life due to AF and concomitant heart disease. In table I a summary of currently available therapeutic options is shown.

Table I – Treatment options for AF treatment in different types of AF

From Waktare and Camm³, modified

Persistent AF may be a difficult field for patients’ management. Indeed, the decision to try to maintain sinus rhythm or, alternatively, to limit treatment to rate control and prevention of tromboembolic risk, should be individualised for each patient, trying to assess the risk-benefit ratio in each clinical case.

Different antiarrhythmic agents, with disparate electrophysiologic effects, have been used for terminating AF episodes or for preventing AF recurrences^4-10. For most patients it is prevention of AF recurrences rather than restoration of sinus rhythm that is the most difficult problem to solve. The limited efficacy of antiarrhythmic agents and the evidence that adverse effects including proarrhythmic effects may be caused by antiarrhythmic treatment led to the development of non-pharmacological treatment, whose cost-benefit profile is in most cases still under evaluation. Non pharmacological treatments developed in recent years for management of AF include atrial pacing, internal atrial cardioversion and catheter or surgical ablation procedures.