Non-pharmacological treatment of atrial fibrillation

Although often denigrated in recent years, antiarrhythmic drugs frequently enable control of atrial fibrillation in patients who are symptomatic or at high risk of complications. In patients resistant to therapy, a number of non-pharmacological options have become available. The choice is no longer limited to his bundle ablation, a method previously at the point of progress but which has gradually given way to more sophisticated and less definitively destructive techniques. Modulation of atrioventricular conduction is currently under development, the feasibility of which has not yet been completely evaluated, but which may provide a less radical alternative in selected patients. Restoration of sinus rhythm by electrical cardioversion has benefitted from the advances of cardiac defibrillation in general. The theoretical information which its use implies has improved its efficacy, especially in the case of endocavitary electrical shock. This method can also be employed with automatic implantable defibrillators but using specific algorithms. Atrial pacing is credited with a preventive efficacy but this has never been definitely demonstrated. Research is under way in this domain. Future hopes are also centered on atrial surgery, especially the operation described by Cox which is generally accepted to be effective and which may be adapted medically using endocavitary radiofrequency current. Most of these methods are insufficiently experimented but they should be considered reasonably in particularly symptomatic patients duely informed of the nature of the treatments which are proposed.