Nonpharmacologic Therapy of Atrial Fibrillation and Atrial Flutter.

The medical therapy of atrial fibrillation and atrial flutter is unsatisfactory for many patients since nonpharmacologic therapy is often necessary. Curative catheter ablation is the treatment of choice for atrial flutter. Primary success rates of 95% are routinely achieved in centers of excellence with relapse rates for atrial flutter of 5%-10%. Nonpharmacologic therapies in atrial fibrillation are more often palliative than curative. Catheter ablation of the AV junction with implantation of a permanent pacemaker is the primary nonpharmacologic therapy for medically refractory atrial fibrillation. The quality of life is improved by AV junction ablation, although survival is not. Curative therapy for atrial fibrillation is available with the surgical maze operation but that is primarily offered in conjunction with concomitant cardiac surgery. Recently a catheter ablative procedure to mimic the maze operation has had preliminary evaluation but remains investigational. A focal ablation procedure for paroxysmal atrial fibrillation has also entered into clinical trials.