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Atrial fibrillation has evolved from being a novel unproven procedure to being an important treatment option for patients with symptomatic atrial fibrillation. Atrial fibrillation ablation is an appropriate treatment option for patients with symptomatic atrial fibrillation, particularly if they have failed one or more trials of antiarrhythmic drug therapy. While much has been learned about the optimal technique and outcomes for catheter ablation of paroxysmal atrial fibrillation; catheter ablation of atrial fibrillation in patients with long standing persistent atrial fibrillation remains in its infancy. The following objectives would be accomplished in this review article. First, we will review the various ablation strategies, which have been employed and proposed for ablation of long standing persistent atrial fibrillation. Second, the methodology, results and outcomes of the major studies were reviewed in detail, which have reported outcomes of ablation in this patient population. And finally, some conclusions were drawn regarding where we stand and where the knowledge gaps remain as we seek to improve ablation outcomes in this population of AF patients. [ABSTRACT FROM AUTHOR]

In patients with recurrent atrial fibrillation (AF), the hallmark of treatment has been the use of antiarrhythmic drugs (AADs). Goals of therapy include reduction in the frequency and duration of episodes of arrhythmia as well an emerging goal of reducing mortality and hospitalizations associated with AF. Safety and efficacy are important factors when choosing an antiarrhythmic drug for the treatment of AF, hence, if AAD are required for maintenance of sinus rhythm, their safety profi le, together with individual patient characteristics, should be of utmost concern. In the next paragraphs we would like to review some aspects (electrophysiologic effects, metabolism, side effects, current evidence and indication) of the most commonly used AAD for the management of patients with AF, following the Vaughan-Williams classification. However, this system is mainly based on ventricular activity, therefore, and due to its relatively atrial selective actions, some agents will not readily fit in the Vaughan Williams AAD classification. For that reason, in the final part of the manuscript, new promising agents will be reviewed separately. [ABSTRACT FROM AUTHOR]

The article presents a study that investigates ways on how to control the rates of atrial fibrillation (AF) and prevent morbidity in patients in the U.S. It offers information on the role of increase heart rates in the morbidity of patients with AF. It presents the efficacy of using anti-arrhythmics and sinus rhythm in controlling AF. It features the medical tools used by doctor to control patients' morbidity and the benefits of controlling the AF morbidity rates. Moreover, the different clinical trials done by researchers andt its results are also mentioned.

Background: To identify and characterise pre-procedural and procedural parameters which predict maintenance of sinus rhythm after a first circumferential pulmonary vein isolation (CPVI) for recurrent atrial fibrillation (AF). Methods: 100 patients (54±10 yrs) undergoing CARTO-guided CPVI for symptomatic drug refractory, paroxysmal or shortstanding persistent AF were studied. The endpoint was complete electrical isolation within the encircled regions. 3D left atrial (LA) volume was measured by CARTO geometry. Follow-up examinations (symptoms, ECG, 24-hour ECG recording) were performed at 1 and 3 months and every 3 months thereafter. Results: After the first CPVI, 71 patients (71%) were free of AF without antiarrhythmic drug therapy (follow up:28±11 months). The only independent and significant predictors for freedom of AF after the first CPVI were duration of AF history and 3D LA volume (p<0.05). However, a significant overlap in durations of AF history and 3D LA volumes between failures and successes was observed. Conclusions: (1) Using the "circumferential pulmonary vein isolation" approach, the first catheter ablation leads to resolution of arrhythmia in ≈ 70% of symptomatic AF patients. (2) Independent predictors for freedom of AF after initial CPVI are duration of AF history and 3D LA volume. (3) Due to considerable overlap between failures and successes, these parameters can not be used to identify patients who should not undergo CPVI or in whom an additional ablation beyond CPVI is required. On the other hand, our results do suggest that an ablation strategy early in the course of AF disease can influence successful outcome. [ABSTRACT FROM AUTHOR]