Background: In patients with drug-refractory atrial fibrillation there are some non-pharmacologic therapeutic options for heart rate control or recurrence prophylaxis that do not primarily aim at the induction or maintenance of atrial fibrillation itself.
Av node ablation and modulation: Using radiofrequency ablation AV nodal conduction can be completely interrupted (AV node ablation) or partly impaired (AV node modulation), which allows subsequent control of the effective ventricular rate (if necessary by pacer maker implantation). Atrial fibrillation, however, does continue undisturbed in the atria, with its associated risk of thromboembolic complications.
Secondary catheter ablation: The other option of a secondary catheter ablation approach to atrial fibrillation consists of a combination of antiarrhythmic medication using Class Ic or III antiarrhythmics and its conversion of atrial fibrillation to isthmus-dependent atrial flutter, which can subsequently be treated by curative bi-directional isthmus blockade. Termination of the antiarrhythmic medication may lead to reoccurrence of atrial fibrillation.
Objectives: The review discusses the mentioned options for secondary catheter ablation of atrial fibrillation together with possible indications, success rates and potential complications.