Nonpharmacologic Treatment for Atrial Fibrillation

On, Young Keun

Abstract

Atrial fibrillation (AF) is the most common cardiac arrhythmia and its prevalence is expected to increase with increasing age. The risk of stroke also increases substantially with age. There are three strategies for the management of AF, that is, rate control, rhythm control and anticoagulation for prevention of embolism. Antiarrhythmic drugs are usually used for rhythm control as first line therapy but there are some limitations in using antiarrhythmic drugs for AF. Catheter ablation of AF should be considered as second line therapy. The primary indication for catheter ablation is the presence of symptomatic AF refractory or intolerant to antiarrhythmic medication. Warfarin is more effective effective in preventing stroke than aspirin and combination aspirin-clopidogrel. Despite its proven efficacy, warfarin is often not well tolerated by patients, has a very narrow therapeutic range, and has a high risk for bleeding complications. Echocardiography and autopsy studies showed that the left atrial appendage (LAA) was the source of thrombi in more than 90% of patients with non-valvular AF. Percutaneous catheter-based devices have been developed to close and thereby effectively exclude the LAA from the systemic circulation.