Advances in the Treatment of Atrial Tachyarrhythmias : Pacing, Cardioversion, and Defibrillation

Atrial fibrillation is a common arrhythmia, difficult to treat pharmac ologically and associated with significant morbidity and mortality. Al though traditionally prescribed when pharmacologic therapy is not effe ctive, not tolerated, or contraindicated, electrical therapy should no longer be considered as a treatment of last resort. Implantable devic es such as cardiac pacemakers and internal defibrillators capable of m onitoring atrial tachyarrhythmias have enhanced understanding of the m echanisms and natural history of atrial tachyarrhythmias. This knowled ge allows electrical therapy to alter the natural course of atrial tac hyarrhythmias early after onset or create an unfavorable electrophysio logical environment in circumstances predisposing to their initiation. Electrical devices offer the promise of prevention and control of at rial tachyarrhythmias, with significant improvements in all health car e professionals dealing with atrial fibrillation and other atrial tach yarrhythmias.