Hybrid Therapy in the Management of Atrial Fibrillation

Abstract

Atrial fibrillation is the most common sustained arrhythmia. Because of the sub-optimal outcomes and associated risks of medical therapy as well as the recent advances in non-pharmacologic strategies, a multitude of combined (hybrid) algorithms have been introduced that improve efficacy of standalone therapies while maintaining a high safety profile. Antiarrhythmic administration enhances success rate of electrical cardioversion. Catheter ablation of antiarrhythmic drug-induced typical atrial flutter may prevent recurrent atrial fibrillation. Through simple ablation in the right atrium, suppression of atrial fibrillation may be achieved in patients with previously ineffective antiarrhythmic therapy. Efficacy of complex catheter ablation in the left atrium is improved with antiarrhythmic drugs. Catheter ablation followed by permanent pacemaker implantation is an effective and safe treatment option for selected patients. Additional strategies include pacing therapies such as atrial pacing with permanent pacemakers, preventive pacing algorithms, and/or implantable dual-chamber defibrillators are available. Modern hybrid strategies combining both epicardial and endocardial approaches in order to create a complex set of radiofrequency lesions in the left atrium have demonstrated a high rate of success and warrant further research. Hybrid therapy for atrial fibrillation reviews history of development of non-pharmacological treatment strategies and outlines avenues of ongoing research in this field.

Application of Gene Therapy for Treatment of Atrial Fibrillation

“…Although more effective than monotherapy, combination treatments are still far from ideal. The most common polytherapy for AF, a combination of catheter ablation and antiarrhythmic drug therapy, was ineffective for 29% of people, according to a study at the Hospital of the University of Pennsylvania (Starek et al, 2015). Therefore, a significant proportion of people with AF cannot be treated effectively with polytherapy.…”

Global research trends in catheter ablation and surgical treatment of atrial fibrillation: A bibliometric analysis and science mapping

“…There are multiple adverse outcomes, including stroke, heart failure, and dementia (4,5). The prevalence and incidence of AF increased significantly year by year, and were related to geography, age, and gender (6,7). Due to the widespread and severe nature of AF, it imposes a huge economic burden on the public health and medical systems in both developed and developing countries.…”

Left atrium phasic impairments in paroxysmal atrial fibrillation patients assessed by cardiovascular magnetic resonance feature tracking

“…Atrial fibrillation (AF) is the most common cardiac arrhythmia, an abnormal and irregular heartbeat caused by uncoordinated electrical impulses in the atria 1 , which could induce lasting changes in the heart tissue or could be a consequence of underlying cardiac disease 2 . AF may lead to severe complications in heart conditions 1 . This progressive disease worsens with age, manifests a broad range of symptoms, and exhibits a steady increase in its prevalence 2 , 3 .…”