Nonpharmacologic therapy of atrial fibrillation

Management of atrial fibrillation, by far the most common sustained arrhythmia seen in clinical practice, is undergoing a profound reshaping, with a better definition of the role of different therapeutic strategies and an increasing impetus directed toward nonpharmacologic approaches for maintenance of sinus rhythm. Medical management using a primary strategy of rate control or rhythm control, along with anticoagulation in appropriate patients, remains the recommended initial treatment for patients who develop this arrhythmia. However, the increasing success of catheter ablation and surgical ablation for atrial fibrillation has led to more patients undergoing these procedures and at more advanced stages of disease. This paper discusses the mechanisms of atrial fibrillation as they relate to ablative strategies, and it reviews the methods and outcomes of various nonpharmacologic approaches to the treatment of atrial fibrillation.