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.
Keywords: Atrial fibrillation, catheter ablation of arrhythmias, pharmacological antiarrhythmic therapy, hybrid therapy.
Graphical Abstract
[1]
Heeringa J, van der Kuip D, Hofman A, et al. Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study. Eur Heart J 2006; 27(8): 949-53.
[2]
Benjamin EJ, Wolf PA, D’Agostino RB, et al. Impact of Atrial Fibrillation on the Risk of Death: the Framingham Heart Study. Circulation 1998; 98(10): 946-52.
[3]
Wolf PA, Dawber TR, Thomas HE Jr, et al. Epidemiologic assessment of chronic atrial fibrillation and risk of stroke: the Framingham Study. Neurology 1978; 28(10): 973-7.
[4]
Krahn AD, Manfreda J, Tate RB, et al. The natural history of atrial fibrillation: incidence, risk factors, and prognosis in the Manitoba Follow-up Study. Am J Med 1995; 98(5): 476-84.
[5]
Miyasaka Y, Barnes ME, Petersen RC, et al. Risk of dementia in stroke-free patients diagnosed with atrial fibrillation: data from a community-based cohort. Eur Heart J 2007; 28(16): 1962-7.
[6]
Benjamin EJ, Chen PS, Bild DE, et al. Prevention of atrial fibrillation: report from a National Heart, Lung, and Blood Institute workshop. Circulation 2009; 119(4): 606-18.
[7]
Miyasaka Y, Barnes ME, Gersh BJ, et al. Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation 2006; 114(2): 119-25.
[8]
Wolf PA, Mitchell JB, Baker CS, et al. Impact of atrial fibrillation on mortality, stroke, and medical costs. Arch Intern Med 1998; 158(3): 229-34.
[9]
Gosselink AT, Crijns HJ, van Gelder IC, et al. Low-dose amiodarone for maintenance of sinus rhythm after cardioversion of atrial fibrillation or flutter. JAMA 1992; 267(24): 3289-93.
[10]
Kerin NZ, Faitel K, Kerin IA, et al. Efficacy of low-dose amiodarone in the prevention of paroxysmal atrial fibrillation resistant to type IA antiarrhythmic drugs. Am J Ther 2000; 7(4): 245-50.
[11]
Investigators, The Cardiac Arrhythmia Suppression Trial-II. Effect of the antiarrhythmic agent moricizine on survival after myocardial infarction. The Cardiac Arrhythmia Suppression Trial II Investigators. N Engl J Med 1992; 327(4): 227-33.
[12]
Oral H, Souza JJ, Michaud GF, et al. Facilitating transthoracic cardioversion of atrial fibrillation with ibutilide pretreatment. N Engl J Med 1999; 340(24): 1849-54.
[13]
Capucci A, Villani GQ, Aschieri D, et al. Oral amiodarone increases the efficacy of direct-current cardioversion in restoration of sinus rhythm in patients with chronic atrial fibrillation. Eur Heart J 2000; 21(1): 66-73.
[14]
Lai LP, Lin JL, Lien WP, et al. Intravenous sotalol decreases transthoracic cardioversion energy requirement for chronic atrial fibrillation in humans: assessment of the electrophysiological effects by biatrial basket electrodes. J Am Coll Cardiol 2000; 35(6): 1434-41.
[15]
Bianconi L, Mennuni M, Lukic V, et al. Effects of oral propafenone administration before electrical cardioversion of chronic atrial fibrillation: a placebo-controlled study. J Am Coll Cardiol 1996; 28(3): 700-6.
[16]
Blomstrom-Lundqvist C, Scheinman MM, Aliot EM, et al. ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias --executive summary: a report of the American college of cardiology/American heart association task force on practice guidelines and the European society of cardiology committee for practice guidelines (writing committee to develop guidelines for the management of patients with supraventricular arrhythmias) developed in collaboration with NASPE-Heart Rhythm Society. J Am Coll Cardiol 2003; 42(8): 1493-531.
[17]
Verma A, Natale A. Why atrial fibrillation ablation should be considered first-line therapy for some patients. Circulation 2005; 112: 1214-22.
[18]
Klein GJ, Guiraudon GM, Sharma AD, et al. Demonstration of macroreentry and feasibility of operative therapy in the common type of atrial flutter. Am J Cardiol 1986; 57: 587-91.
[19]
Feld GK, Fleck RP, Chen PS, et al. Radiofrequency catheter ablation for the treatment of human type 1 atrial flutter. Identification of a critical zone in the reentrant circuit by endocardial mapping techniques. Circulation 1992; 86(4): 1233-40.
[20]
Fischer B, Haïssaguerre M, Garrigues S, et al. Radiofrequency catheter ablation of common atrial flutter in 80 patients. J Am Coll Cardiol 1995; 25(6): 1365-72.
[21]
Schwartzman D, Callans DJ, Gottlieb CD, et al. Conduction block in the inferior vena caval-tricuspid valve isthmus: association with outcome of radiofrequency ablation of type I atrial flutter. J Am Coll Cardiol 1996; 28(6): 1519-31.
[22]
Poty H, Saoudi N, Nair M, et al. Radiofrequency catheter ablation of atrial flutter. Further insights into the various types of isthmus block: application to ablation during sinus rhythm. Circulation 1996; 94(12): 3204-13.
[23]
Jaïs P, Haïssaguerre M, Shah DC, et al. Successful irrigated-tip catheter ablation of atrial flutter resistant to conventional radiofrequency ablation. Circulation 1998; 98(9): 835-8.
[24]
Roithinger FX, Karch MR, Steiner PR, et al. Relationship between atrial fibrillation and typical atrial flutter in humans: activation sequence changes during spontaneous conversion. Circulation 1997; 96: 3484-91.
[25]
Murdock CJ, Kyles AE, Yeung-Lai-Wah JA, et al. Atrial flutter in patients treated for atrial fibrillation with propafenone. Am J Cardiol 1990; 66(7): 755-7.
[26]
Stabile G, De Simone A, Turco P, et al. Response to flecainide infusion predicts long-term success of hybrid pharmacologic and ablation therapy in patients with atrial fibrillation. J Am Coll Cardiol 2001; 37(6): 1639-44.
[27]
Reithmann C, Hoffmann E, Spitzlberger G, et al. Catheter ablation of atrial flutter due to amiodarone therapy for paroxysmal atrial fibrillation. Eur Heart J 2000; 21(7): 565-72.
[28]
Schumacher B, Jung W, Lewalter T, et al. Radiofrequency ablation of atrial flutter due to administration of class IC antiarrhythmic drugs for atrial fibrillation. Am J Cardiol 1999; 83(5): 710-3.
[29]
Reithmann C, Dorwarth U, Dugas M, et al. Risk factors for recurrence of atrial fibrillation in patients undergoing hybrid therapy for antiarrhythmic drug-induced atrial flutter. Eur Heart J 2003; 24(13): 1264-72.
[30]
Cox JL, Canavan TE, Schuessler RB, et al. The surgical treatment of atrial fibrillation. II: Intraoperative electrophysiologic mapping and description of the electrophysiologic basis of atrial flutter and atrial fibrillation. J Thorac Cardiovasc Surg 1991; 101(3): 406-26.
[31]
Cox JL, Boineau JP, Schuessler RB, et al. Five year experience with the Maze procedure for atrial fibrillation. Ann Thorac Surg 1993; 56(4): 814-23. discussion 823-4.
[32]
Defauw JJ, Guiraudon GM, van Hemel NM, et al. Surgical therapy of paroxysmal atrial fibrillation with the “corridor” operation. Ann Thorac Surg 1992; 53(4): 564-70. discussion 571.
[33]
Elvan A, Pride HP, Eble JN, et al. Radiofrequency catheter ablation of the atria reduces inducibility and duration of atrial fibrillation in dogs. Circulation 1995; 91: 2235-44.
[34]
Haïssaguerre M, Gencel L, Fischer B, et al. Successful catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol 1994; 5(12): 1045-52.
[35]
Haïssaguerre M, Jaïs P, Shah DC, et al. Right and left atrial radiofrequency catheter therapy of paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol 1996; 7(12): 1132-44.
[36]
Kocheril AG, Calkins H, Sharma AD, et al. Hybrid therapy with right atrial catheter ablation and previously ineffective antiarrhythmic drugs for the management of atrial fibrillation. J Interv Card Electrophysiol 2005; 12(3): 189-97.
[37]
Chakravarty S, Chatterjee S. Efficacy of hybrid therapy in the form of right atrial ablation and adjunctive therapy in refractory atrial fibrillation in symptomatic patients. Am J Ther 2012; 19(1): e18-20.
[38]
Calkins H, Kuck KH, Cappato R, et al. 2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. Europace 2012; 14(4): 528-606.
[39]
Leong-Sit P, Roux JF, Zado E, et al. Antiarrhythmics After Ablation of Atrial Fibrillation (5A Study): Six-Month Follow-Up Study. Circ Arrhythm Electrophysiol 2011; 4(1): 11-4.
[40]
Koyama T, Tada H, Sekiguchi Y, et al. Prevention of Atrial Fibrillation Recurrence With Corticosteroids After Radiofrequency Catheter Ablation A Randomized Controlled Trial. J Am Coll Cardiol 2010; 56(18): 1463-72.
[41]
Calkins H, Reynolds MR, Spector P, et al. Treatment of atrial fibrillation with antiarrhythmic drugs or radiofrequency ablation: two systematic literature reviews and meta-analyses. Circ Arrhythm Electrophysiol 2009; 2(4): 349-61.
[42]
Cappato R, Calkins H, Chen SA, et al. Updated Worldwide Survey on the Methods, Efficacy, and Safety of Catheter Ablation for Human Atrial Fibrillation. Circ Arrhythm Electrophysiol 2010; 3(1): 32-8.
[43]
Zado E, Callans DJ, Riley M, et al. Long-term clinical efficacy and risk of catheter ablation for atrial fibrillation in the elderly. J Cardiovasc Electrophysiol 2008; 19(6): 621-6.
[44]
Scheinman MM, Morady F, Hess DS, et al. Catheter-induced ablation of the atrioventricular junction to control refractory supraventricular arrhythmias. JAMA 1982; 248(7): 851-5.
[45]
Gallagher JJ, Svenson RH, Kasell JH, et al. Catheter technique for closed-chest ablation of the atrioventricular conduction system. N Engl J Med 1982; 306(4): 194-200.
[46]
Huang SK, Bharati S, Graham AR, et al. Closed chest catheter desiccation of the atrioventricular junction using radiofrequency energy–a new method of catheter ablation. J Am Coll Cardiol 1987; 9(2): 349-58.
[47]
Langberg JJ, Chin MC, Rosenqvist M, et al. Catheter ablation of the atrioventricular junction with radiofrequency energy. Circulation 1989; 80(6): 1527-35.
[48]
Olgin JE, Scheinman MM. Comparison of high energy direct current and radiofrequency catheter ablation of the atrioventricular junction. J Am Coll Cardiol 1993; 21(3): 557-64.
[49]
Hoffmayer KS, Scheinman M. Current Role of Atrioventricular Junction (AVJ) Ablation. Pacing Clin Electrophysiol 2013; 36(2): 257-65.
[50]
Marshall HJ, Griffith MJ. Ablation of the atrioventricular junction: Technique, acute and long-term results in 115 consecutive patients. Europace 1999; 1(1): 26-9.
[51]
Kay GN, Ellenbogen KA, Giudici M, et al. The Ablate and Pace Trial: a prospective study of catheter ablation of the AV conduction system and permanent pacemaker implantation for treatment of atrial fibrillation. APT Investigators. J Interv Card Electrophysiol 1998; 2(2): 121-35.
[52]
Ozcan C, Jahangir A, Friedman PA, et al. Sudden death after radiofrequency ablation of the atrioventricular node in patients with atrial fibrillation. J Am Coll Cardiol 2002; 40(1): 105-10.
[53]
Geelen P, Brugada J, Andries E, et al. Ventricular Fibrillation and Sudden Death After Radiofrequency Catheter Ablation of the Atrioventricular Junction. Pacing Clin Electrophysiol 1997; 20(2 Pt 1): 343-8.
[54]
Thambo JB, Bordachar P, Garrigue S, et al. Detrimental ventricular remodeling in patients with congenital complete heart block and chronic right ventricular apical pacing. Circulation 2004; 110(25): 3766-72.
[55]
Healey J, Yee R, Tang A. Right ventricular apical pacing: a necessary evil? Curr Opin Cardiol 2007; 22(1): 33-8.
[56]
Tops LF, Schalij MJ, Holman ER, et al. Right ventricular pacing can induce ventricular dyssynchrony in patients with atrial fibrillation after atrioventricular node ablation. J Am Coll Cardiol 2006; 48(8): 1642-8.
[57]
Shinbane JS, Wood MA, Jensen DN, et al. Tachycardia-induced cardiomyopathy: A review of animal models and clinical studies. J Am Coll Cardiol 1997; 29(4): 709-15.
[58]
Lim KT, Davis MJ, Powell A, et al. Ablate and pace strategy for atrial fibrillation: long-term outcome of AIRCRAFT trial. Europace 2007; 9(7): 498-505.
[59]
Ozcan C, Jahangir A, Friedman PA, et al. Long-term survival after ablation of the atrioventricular node and implantation of a permanent pacemaker in patients with atrial fibrillation. N Engl J Med 2001; 344(14): 1043-51.
[60]
Doshi RN, Daoud EG, Fellows C, et al. Left ventricular-based cardiac stimulation post AV nodal ablation evaluation (the PAVE study). J Cardiovasc Electrophysiol 2005; 16(11): 1160-5.
[61]
Brignole M, Botto G, Mont L, et al. Cardiac resynchronization therapy in patients undergoing atrioventricular junction ablation for permanent atrial fibrillation: a randomized trial. Eur Heart J 2011; 32(19): 2420-9.
[62]
Stavrakis S, Garabelli P, Reynolds DW. Cardiac resynchronization therapy after atrioventricular junction ablation for symptomatic atrial fibrillation: a meta-analysis. Europace 2012; 14(10): 1490-7.
[63]
Hamdan MH, Freedman RA, Gilbert EM, et al. Atrioventricular junction ablation followed by resynchronization therapy in patients with congestive heart failure and atrial fibrillation (AVERT-AF) study design. Pacing Clin Electrophysiol 2006; 29(10): 1081-8.
[64]
Fuster V, Ryden LE, Cannom DS, et al. 2011 ACCF/AHA/HRS Focused Updates Incorporated into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2011; 123: 104-23.
[65]
Tse HF, Lau CP, Ayers GM, et al. Incidence and modes of onset of early reinitiation of atrial fibrillation after successful internal cardioversion, and its prevention by intravenous sotalol. Heart 1999; 82: 319-24.
[66]
Roithinger FX, Karch MR, Steiner PR, et al. The spatial dispersion of atrial refractoriness and atrial fibrillation vulnerability. J Interv Card Electrophysiol 1999; 3(4): 311-9.
[67]
Rosenqvist M, Brandt J, Schüller H, et al. Long-term pacing in sinus node disease: effects of stimulation mode on cardiovascular morbidity and mortality. Am Heart J 1988; 116(1 Pt 1): 16-22.
[68]
Gillis AM, Connolly SJ, Lacombe P, et al. Randomized crossover comparison of DDDR versus VDD pacing after atrioventricular junction ablation for prevention of atrial fibrillation. The atrial pacing peri-ablation for paroxysmal atrial fibrillation (PA (3)) study investigators. Circulation 2000; 102(7): 736-41.
[69]
Simantirakis EN, Arkolaki EG, Vardas PE, et al. Novel pacing algorithms: do they represent a beneficial proposition for patients, physicians, and the health care system? Europace 2009; 11(10): 1272-80.
[70]
Carlson MD, Ip J, Messenger J, Beau S, et al. A new pacemaker algorithm for the treatment of atrial fibrillation: results of the Atrial Dynamic Overdrive Pacing Trial (ADOPT). J Am Coll Cardiol 2003; 42(4): 627-33.
[71]
Simpson RJ Jr, Foster JR, Gettes LS, et al. Atrial excitability and conduction in patients with interatrial conduction defects. Am J Cardiol 1982; 50(6): 1331-7.
[72]
Cohen J, Scherf D. Complete interatrial and intra-atrial block (atrial dissociation). Am Heart J 1965; 70: 24-34.
[73]
D’Allonnes GR, Pavin D, Leclercq C, et al. Long-term effects of biatrial synchronous pacing to prevent drug-refractory atrial tachyarrhythmia: a nine-year experience. J Cardiovasc Electrophysiol 2000; 11(10): 1081-91.
[74]
Delfaut P, Saksena S, Prakash A, et al. Long-term outcome of patients with drug-refractory atrial flutter and fibrillation after single- and dual-site right atrial pacing for arrhythmia prevention. J Am Coll Cardiol 1998; 32(7): 1900-8.
[75]
Saksena S, Prakash A, Ziegler P, et al. Improved suppression of recurrent atrial fibrillation with dual-site right atrial pacing and antiarrhythmic drug therapy. J Am Coll Cardiol 2002; 40(6): 1140-50. discussion 1151-2.
[76]
Papageorgiou P, Monahan K, Boyle NG, et al. Site-dependent intra-atrial conduction delay. Relationship to initiation of atrial fibrillation. Circulation 1996; 94(3): 384-9.
[77]
Padeletti L, Pieragnoli P, Ciapetti C, et al. Randomized crossover comparison of right atrial appendage pacing versus interatrial septum pacing for prevention of paroxysmal atrial fibrillation in patients with sinus bradycardia. Am Heart J 2001; 142(6): 1047-55.
[78]
Ricci R, Pignalberi C, Disertori M, et al. Antitachycardia pacing therapy to treat spontaneous atrial tachyarrhythmias: the 7250 dual defibrillator Italian Registry. Eur Heart J Suppl 2001; 3(Suppl. P): 25-32.
[79]
Wijffels MC, Kirchhof CJ, Dorland R, et al. Atrial fibrillation begets atrial fibrillation. A study in awake chronically instrumented goats. Circulation 1995; 92(7): 1954-68.
[80]
Wellens HJ, Lau CP, Lüderitz B, et al. Atrioverter: an implantable device for the treatment of atrial fibrillation. Circulation 1998; 98(16): 1651-6.
[81]
Geller JC, Reek S, Timmermans C, et al. Treatment of atrial fibrillation with an implantable atrial defibrillator--long term results. Eur Heart J 2003; 24(23): 2083-9.
[82]
Ricci R, Pignalberi C, Disertori M, et al. Efficacy of a dual chamber defibrillator with atrial antitachycardia functions in treating spontaneous atrial tachyarrhythmias in patients with life-threatening ventricular tachyarrhythmias. Eur Heart J 2002; 23(18): 1471-9.
[83]
Botto GL, Boriani G, Favale S, et al. Treatment of atrial fibrillation with a dual defibrillator in heart failure patients (TRADE HF): protocol for a randomized clinical trial. Trials 2011; 12: 44.
[84]
Pokushalov E, Romanov A, Corbucci G, et al. A randomized comparison of pulmonary vein isolation with versus without concomitant renal artery denervation in patients with refractory symptomatic atrial fibrillation and resistant hypertension. J Am Coll Cardiol 2012; 60(13): 1163-70.
[85]
Callans DJ, Gerstenfeld EP, Dixit S, et al. Efficacy of repeat pulmonary vein isolation procedures in patients with recurrent atrial fibrillation. J Cardiovasc Electrophysiol 2004; 15(9): 1050-5.
[86]
Lockwood D, Nakagawa H, Peyton MD, et al. Linear left atrial lesions in minimally invasive surgical ablation of persistent atrial fibrillation: techniques for assessing conduction block across surgical lesions. Heart Rhythm 2009; 6(12 Suppl.): S50-63.
[87]
Zembala M, Filipiak K, Kowalski O, et al. Minimally invasive hybrid ablation procedure for the treatment of persistent atrial fibrillation: one year results. Kardiol Pol 2012; 70(8): 819-28.
[88]
Gehi AK, Mounsey JP, Pursell I, et al. Hybrid epicardial-endocardial ablation using a pericardioscopic technique for the treatment of atrial fibrillation. Heart Rhythm 2013; 10(1): 22-8.
Article Metrics
35
2
1
1