NEW YORK (Reuters Health) - Extended treatment of atrial fibrillation (AF) with an implantable atrial defibrillator (IAD) is feasible in select patients with symptomatic, drug-refractory paroxysmal or persistent AF, German cardiologists report in the December issue of the European Heart Journal.
“It was known before this study that this type of aggressive therapy is safe and effective in the short run but there were a lot of questions regarding long-term tolerance of repeated (and sometimes frequent) cardioversion shocks,” Dr. J. Christoph Geller from University Hospitals of Magdeburg told Reuters Health. (See Reuters Health reports Oct. 20, 1998 and Oct. 19, 1999).
Dr. Geller’s team followed 106 patients with recurrent symptomatic drug-refractory AF implanted with the METRIX atrioverter (Guidant Corp, St. Paul, MN) for a median of 40 months.
At last follow up, “50% of patients continued to use the device either to treat or to monitor AF and attempts to maintain sinus rhythm were continued in two-thirds of patients,” the team reports.
The remaining 50% of patients had abandoned the device, having it turned off or explanted.
“Frequent recurrences of the arrhythmia (including early recurrence of atrial fibrillation after initially successful cardioversion shocks) and patient discomfort with repeated cardioversion shocks were the main limitation of this type of therapy and the main reason for discontinuation,” Dr. Geller said.
“Therefore, further improvements of technical aspects of these devices and additional drug therapy will likely be needed to allow more patients to benefit from this type of therapy,” Dr. Geller added.
Dr. Andrew R. Mitchell from John Radcliffe Hospital in Oxford, England writes in an editorial that choosing the right patient for the IAD is “vital for long-term success. The ideal patient appears to be a motivated patient with recurrent drug-resistant, highly symptomatic persistent AF that requires frequent hospitalization for cardioversion.”
“With careful patient selection, the use of the atrial defibrillator empower patients to ‘take charge’ of their condition and liberate them from the fear of recurrent hospitalization,” Dr. Mitchell writes.
Source: Euro Heart J 2003;24:2075-2076,2083-2089. [ Google search on this article ]
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