Treatment
24
Pacemakers and Implantable Cardioverter-Defibrillators in the
Management of AF
Î The primary role of pacemakers in the treatment of patients with AF
is for treatment of symptomatic bradycardia. Permanent pacing is not
indicated for the prevention of AF in patients without other indications
for pacemaker implantation.
Athletes
Î Paroxysmal or persistent AF is common in athletes and may be
autonomically mediated or triggered by other supraventricular
tachycardias. Contributing conditions such as hypertension and
CAD should be considered, particularly for older athletes, and a
transthoracic echocardiogram is helpful to evaluate for structural
heart disease. Evaluation of the rate of ventricular response during
an episode of AF is warranted and may require ambulatory ECG
monitoring and/or exercise testing to a level of exertion similar to
that of the intended sport. Other therapies such as radiofrequency
catheter ablation or a "pill-in-the-pocket" approach can be considered
in athletes.
Elderly
Î It is critical to consider the implications of comorbidities to ensure
that the patient's overall goals of care are factored into management
decisions.
Table 17. Surgical Maze Procedures
Recommendations COR LOE
An AF surgical ablation procedure is reasonable for selected
patients with AF undergoing cardiac surgery for other
indications.
IIa C
A stand-alone AF surgical ablation procedure may be
reasonable for selected patients with highly symptomatic AF
not well managed with other approaches.
IIb B
