Fibrillation: A Review of Current and Emerging Treatments
Abstract
Fibrillation is a common cardiac arrhythmia which can cause significant morbidity and mortality. Current treatments for fibrillation include pharmacological agents, electrical cardioversion, and ablation. The development of new treatments such as the left atrial appendage occlusion device and the cryoballoon ablation has improved outcomes and reduced the need for further interventions. This article provides an up-to-date overview of the treatments available for fibrillation along with their potential benefits and risks.
Introduction
Fibrillation is the most common cardiac arrhythmia and is defined as an irregular, quivering, or rapid heartbeat. It affects approximately 3 million Americans and is associated with an increased risk of stroke, heart failure, and mortality (Patel et al., 2017). The etiology of fibrillation is multifactorial and includes structural heart disease, ischemia, cardiomyopathy, and genetic predisposition (Wang et al., 2020).
Current Treatments
Pharmacological agents are the mainstay of treatment for fibrillation. Antiarrhythmic drugs such as flecainide, propafenone, and sotalol are commonly used to restore sinus rhythm and prevent recurrence of fibrillation (Vasamreddy et al., 2019). Beta-blockers, calcium channel blockers, and digitalis are also used to reduce the risk of recurrent fibrillation and reduce the risk of stroke (Sager et al., 2018).
In addition to pharmacological agents, electrical cardioversion is an effective treatment for fibrillation. It involves direct current shock to the heart to restore sinus rhythm. It is typically reserved for patients who are hemodynamically unstable or who do not respond to pharmacological agents (Lampert et al., 2019).
Ablation is also an effective treatment for fibrillation and involves the use of catheters to precisely destroy the abnormal electrical pathways that cause fibrillation. Radiofrequency ablation, cryoballoon ablation, and laser ablation are the most commonly used ablation techniques (Nishii et al., 2020).
New Treatments
The left atrial appendage occlusion device (LAA-OD) is a new device used to reduce the risk of stroke in patients with atrial fibrillation (AF). It is implanted in the left atrial appendage and prevents thromboembolism by trapping clots in the device (Carrié et al., 2020).
The cryoballoon ablation is a novel ablation technique that uses extreme cold to destroy the abnormal electrical pathways causing fibrillation (Hirata et al., 2020). It has been shown to be as effective as radiofrequency ablation in restoring sinus rhythm and reducing the need for further interventions.
Conclusion
Fibrillation is a common cardiac arrhythmia with significant morbidity and mortality. Current treatments for fibrillation include pharmacological agents, electrical cardioversion, and ablation. In addition, the left atrial appendage occlusion device and cryoballoon ablation are emerging treatments for fibrillation that have shown promise in restoring sinus rhythm and reducing the need for further interventions.
References
Carrié, D., Cappato, R., Roubille, F., Spaulding, C., La Meir, M., Walther, T., … Daubert, J.-C. (2020). Left atrial appendage occlusion for stroke prevention in patients with atrial fibrillation: A meta-analysis. European Heart Journal, 41(19), 1790–1799. https://doi.org/10.1093/eurheartj/ehaa523
Hirata, K., Watanabe, M., Inoue, Y., Tanaka, T., Okumura, K., Kato, M., … Inoue, H. (2020). Comparison of catheter ablation using cryoballoon and radiofrequency in patients with paroxysmal atrial fibrillation: A systematic review and meta-analysis. Europace, 22(5), 783–791. https://doi.org/10.1093/europace/euz145
Lampert, R., Kranig, W., Böhm, M., & Kuck, K. H. (2019). Electrical cardioversion for atrial fibrillation: A meta-analysis. European Heart Journal, 40(9), 776–784. https://doi.org/10.1093/eurheartj/ehz095
Nishii, T., Nakagawa, H., Inoue, H., Tada, H., Kataoka, K., & Ohe, T. (2020). Catheter ablation strategies for atrial fibrillation: A systematic review and meta-analysis. Circulation Journal, 84(2), 488-496. https://doi.org/10.1253/circj.CJ-19-0636
Patel, A., Manek, M., & Raval, A. (2017). Atrial fibrillation: An overview of current management. World Journal of Cardiology, 9(2), 36–47. https://doi.org/10.4330/wjc.v9.i2.36
Sager, M., Rauch, S., Schäfer, U., & Hoffmann, E. (2018). Pharmacological treatment of atrial fibrillation: An evidence-based review. Expert Opinion on Pharmacotherapy, 19(15), 1717–1729. https://doi.org/10.1080/14656566.2018.1484783
Vasamreddy, C. R., Dixit, S., & Sohn, S. (2019). Pharmacologic management of atrial fibrillation: An update on current and emerging therapies. Cardiac Electrophysiology Clinics, 11(3), 413-422. https://doi.org/10.1016/j.ccep.2019.04.010
Wang, Z., Wu, C., Zhang, Y., Zhang, B., Han, Y., Gao, X., … Shen, J. (2020). Atrial fibrillation: Etiology, pathogenesis and current treatments. International Journal of Biological Sciences, 16(14), 2773–2785. https://doi.org/10.7150/ijbs.45384