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Patients with atrial fibrillation who develop symptomatic bradycardia (slow heart rate) as a consequence of antiarrhythmic drug therapy or who have a high-degree of atrioventricular (AV) block may require implantation of a permanent pacemaker. A pacemaker is a device that sends electrical impulses to the heart muscle to maintain an appropriate heart rate. Various pacemaker strategies are available including atrial pacing without ventricular pacing, single-chamber ventricular pacing, or dual-chamber pacing. If you require a pacemaker, your doctor will determine an optimal pacing strategy for you based on the dual objectives of better managing the arrhythmia and optimizing heart-rate function to the greatest extent possible.

Implantable Cardioverter-Defibrillator

Implantable cardioverter-defibrillators (ICDs) have been used for several years for patients who are prone to develop ventricular fibrillation and are at risk for sudden death. Ventricular fibrillation is a serious condition in which the ventricles of the heart contract in rapid and unsynchronized rhythms so that the heart cannot efficiently pump blood to the body. Implantable cardioverter-defibrillators are programmed to automatically respond to an episode of atrial fibrillation with a small shock delivered inside the heart to convert the atrial fibrillation back to normal sinus rhythm. These devices can be used for patients with recurrent, highly symptomatic atrial fibrillation who do not respond to therapy with antiarrhythmic medications.

Percutanous Left Atrial Appendage Transcatheter Occlusion (PLAATO)

A new technique is being investigated to prevent blood clots from forming in the left atrial appendage and causing stroke, especially in patients who cannot take anticoagulant medications. PLAATO is a percutaneous left atrial appendage transcatheter occlusion system which is introduced through the venous system during a cardiac catheterization procedure. This device has a self-expanding nitinol cage which is covered with a polymeric membrane. The device is inserted via the catheter into the left atrial appendage and held in place by small anchors which protrude through the membrane and hold the device in the mouth of the left atrial appendage. The catheter is then removed leaving this occluding device in place. Studies have shown that once this occluding device occupies the left atrial appendage, there is a marked decrease in the chance of clot formation and stroke.

For additional information about PLAATO, the reader is referred to the following articles:

• Left atrial structure and function after percutaneous left atrial appendage transcatheter occlusion (PLAATO): six-month echocardiographic follow-up. Journal of the American College of Cardiology 2004 May 19;43(10):1868-72.

  Abstract Link:
  
  http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15145113

• Percutaneous left atrial appendage transcatheter occlusion to prevent stroke in high-risk patients with atrial fibrillation: early clinical experience. Circulation 2002 Apr 23;105(16):1887-9.

  Abstract Link:
  
  http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11997272