Hybrid pharmacologic and ablative therapy: A novel and effective approach for the management of atrial fibrillation

Hybrid Therapy for Atrial Fibrillation, Introduction: Maintenance of sinus rhythm in patients with recurrent atrial fibrillation is often difficult to achieve with pharmacologic therapy. Complex catheter ablative procedures are being developed, but efficacy and safety issues remain to be clarified. We hypothesized that combined pharmacologic and simple ablative therapies in a targeted subset of patients will improve success in the treatment of atrial fibrillation. Methods and Results: We identified 13 patients (mean age 61.5 +/- 16.2 Sears) with atrial fibrillation who converted to electrocardiographic atrial nutter during antiarrhythmic drug treatment. Surface ECG suggested "typical" atrial nutter in 11 patients and "atypical" atrial nutter in 2. Intracardiac mapping and entraimment studies revealed 9 patients had counterclockwise isthmus-dependent atrial nutter, and the remaining 4 had complex activation patterns, suggesting the presence of multiple wavefronts. All 9 patients with typical atrial nutter underwent successful ablation. None of the 4 patients with complex activation patterns had successful ablation. Patients were followed for recurrences of atrial arrhythmias via clinic visits, record review, and interviews. In patients who underwent successful ablation and continued on antiarrhythmic drugs, 88.9% remain in sinus rhythm after a mean follow-up of 14.3 +/- 6.9 months (range 1 to 28). Conclusion: In patients who experience conversion of atrial fibrillation to atrial nutter during antiarrhythmic drug treatment, ablation and continuation of pharmacologic therapy is a safe and effective means of achieving and maintaining sinus rhythm.