Giuseppe Boriani, Mauro Biffi, Claudia Camanini, Ivan Corazza, Romano Zannoli, Angelo Branzi.
Institute of Cardiology, University of Bologna, Bologna, Italy
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Different antiarrhythmic agents, with disparate electrophysiologic
effects, have been used for terminating atrial fibrillation (AF) episodes or for preventing AF recurrences. For
most patients it is prevention of AF recurrences rather than restoration of sinus rhythm that is the most
difficult problem to be solved. 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.
Despite these current limitations, non-pharmacological techniques may convey significant advantages to AF
treatment in appropriately selected groups of patients. One of the perspectives to be followed in the next
future is to use, in appropriately selected patients, combined strategies or hybrid therapies. This possibility is
justified by two expectations 1) some of non pharmacological treatments may render AF responsive to
previously ineffective drugs and 2) the combined use of more than one non pharmacological treatment is
expected to be required, alone or in combination to drugs, in some patients, in order to obtain a synergetic
effect. Prospective studies are required to evaluate the risk-benefit profile of these strategies in
appropriately selected patients.
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