Present concepts in management of atrial fibrillation: From drug therapy to ablation

Table 1 Different electrical cardioversion techniques: advantages, disadvantages and efficacy

	Advantages	Disadvantages	Efficacy (%)
External cardioversion	Safety Effectiveness Feasibility Outpatient regimen (not in all the centers)	General anaesthesia (physical presence of anaesthesiologist) Need of high energies	94
Oesophageal cardioversion	Efficacy with lower energies Outpatient regimen No general anesthesia First choice in obese and COPD patients Safety in patients with pacemaker or ICD Atrial pacing back up	High cost of the catheter Contraindicated in patients with oesophageal diseases	95
Internal cardioversion	Very high effectiveness Use of very low energy No general anaesthesia	Need of an electrophysiology laboratory Invasive approach Pain perception	93

Table 2 Randomized trials comparing radiofrequency ablation with antiarrhythmic medications

Study	n	Follow-up(mo)	Patients free of AF			No. of ablation procedures	Major complications(ablation arm) (%)	Type of AF
			Ablation strategy (%)	AAD strategy (%)	P
Wazni et al[48] (2005)	70	12	88	37	< 0.001	1	6.3	Paroxysmal persistent
Oral et al[50] (2006)	146	12	74	58	0.05	1.4	0	Permanent
Stabile et al[49] (2006)	137	12	56	9	< 0.001	1	4.4	Paroxysmal persistent
Pappone et al[51] (2006)	198	12	86	22	< 0.001	1	2.0	Paroxysmal
Jaïs et al[52] (2008)	112	12	88	24	< 0.001	1.8	1.9	Paroxysmal
Forleo et al[53] (2009)	70	12	80	57	0.001	1	2.9	Paroxysmal persistent

All studies demonstrated the superiority of catheter ablation over anti-arrhythmic drugs in AF patients with regard to maintenance of sinus rhythm. AF: Atrial fibrillation; AAD: Anti-arrhythmic drug.