[Interventional treatment methods in atrial fibrillation]

Currently, interventional treatment modalities for atrial fibrillation chiefly comprise experimental techniques. Among the rate-control procedures, AV-nodal ablation in conjunction with permanent pacemaker implantation and transcatheter radiofrequency modulation of the AV-node are clinically accepted techniques. In contrast, the original corridor operation--which electrically isolates the left and right atrium from the sinus- and AV-node--has been changed over time and ultimately led to the development of the MAZE procedure. Among the procedures for maintenance of sinus rhythm, permanent atrial pacing and bi-atrial pacing may offer an effective--though still experimental--treatment modality in selected patients with vagally mediated or bradycardia-induced atrial fibrillation. Despite the fact that the MAZE procedure is highly effective in restoring sinus rhythm and associated with a reasonably low surgical mortality, the morbidity and complication rate of this procedure are high. Automated transvenous low-energy atrioversion may offer an interesting alternative in the future. However, there remain some significant limitations, such as the pain associated with low-energy shocks, the risk of ventricular fibrillation induction and the cost-benefit issue which needs to be solved before this technique can become clinically applicable. Last but not least, transcatheter radio frequency ablation of atrial fibrillation, a still highly investigational technique, may have the potential to revolutionize interventional therapy of atrial fibrillation in the future. For this to occur, however, the technique still needs significant improvement. In conclusion, although their current impact on clinical practice is rather small, interventional techniques for treatment of atrial fibrillation are rapidly developing and will certainly change our therapeutic strategies in the near future.