Atrial fibrillation: treatment rationale and clinical utility of nonpharmacologic therapies

Atrial fibrillation (AF) is the most common sustained cardiac dysrhythmia requiring therapy. Nonpharmacologic therapies for the treatment of AF, namely, catheter ablation, cardiac pacing, internal defibrillation, and dysrhythmia surgery are playing an increasingly important role in the overall management of AF. Although usually prescribed when traditional pharmacologic therapy is not effective, not tolerated, or contraindicated, these therapies are rapidly assuming a more prominent role as they mature. These modern therapies for AF, offering the promise of prevention and cure of AF, potential elimination from the sequelae of AF, and significant improvements in quality of life, are increasingly becoming more frequent in clinical practice. Further investigation is needed to determine which therapy is ideally suited for an individual patient and the impact of these varying therapies on morbidity and mortality.