Long-Standing Persistent Atrial Fibrillation

The Metastatic Cancer of Electrophysiology^⁎⁎

Since the first reports of ablation therapy being used to treat atrial fibrillation, the field has exploded with studies, new techniques, and new technologies (1). It is no wonder that such fervor is associated with this topic. Our medical options to maintain sinus rhythm have been generally poorly effective, riddled with side effects, and in some cases associated with increased mortality ((2),3). Even in the AFFIRM (Atrial Fibrillation Follow-up Investigation of Rhythm Management) trial, the largest study of atrial fibrillation to date, patients did better in sinus rhythm, but the medical therapy was poorly effective and possibly detrimental. This study is often cited as showing that rate control and rhythm control are equivalent, but the investigators’ own conclusion suggest otherwise by stating, “If an effective method for maintaining sinus rhythm with fewer adverse effects were available, it might be beneficial” (4). Patients are also actively seeking alternatives to antiarrhythmic drug therapy. Although the symptomatic spectrum of atrial fibrillation is broad, patients with symptoms frequently do not accept ineffective medications or side effects, and many physicians find patients requesting ablation therapy. This is somewhat unique for electrophysiologists. In the case of implantable devices, patients are seen in the hospital or referred from cardiologists.  Read more