Non-pharmacological therapy of atrial fibrillation and flutter

Atrial fibrillation and atrial flutter are the most frequent arrhythmias encountered by the cardiologists in an everyday practice. External cardioversion, atrial temporary pacing and/or drugs are commonly and often successfully used in their treatment. The failures of these methods are rare, and for the patients who remain prone to arrhythmias or a recurrence with serious hemodynamic consequences, new therapies are presently under assessment. Electrical internal cardioversion can be performed when a permanent and bad tolerated atrial fibrillation is not managed by an external cardioversion. Elective ablation of a reentrant area will be probably the best solution to treat a recurrent atrial flutter or a junctional tachycardia by intranodal reentry. Finally, a radical solution consists to separate electrically the atria from the ventricles by interrupting totally or partially the A-V conduction. This can be performed by an endocavitary fulguration or an ablation by radiofrequency currents. To avoid recurrences, we usually use a pharmacological therapy. Permanent pacing is an exceptional solution.