The role of pacemaker and defibrillator therapy for the treatment of atrial fibrillation.

The development of pacemaker and defibrillator technology has provided a new direction for the treatment of recurrent symptomatic atrial fibrillation (AF). Sophisticated atrial preventative pacing algorithms are now available and newer implantable devices have additional atrial termination pacing therapies. Results from studies examining the effectiveness of atrial anti-tachycardia pacing algorithms have suggested that 50% of atrial arrhythmias (including AF) can be pace terminated using these devices. The atrial defibrillator has recently been shown to be a safe and effective method of restoring and maintaining sinus rhythm in selected patients. Symptoms and quality of life can be improved and some patients demonstrate increased sinus rhythm duration (sinus rhythm begets sinus rhythm) with repeated use of the device. This review article discusses the current application of device therapy for the management of AF and explores some of the merits and limitations of these devices.