Amiodarone is at least as effective as, if not more effective than, the other agents mentioned and, in patients with cardiomyopathy, has a better safety profile with regard to the development of torsade de pointes. Sinus node dysfunction can be exacerbated, and permanent atrial pacing may be indicated. None of the drugs mentioned are completely benign in patients with decreased left ventricular function. For this patient population, in-hospital initiation of antiarrhythmic drug therapy during telemetry monitoring is advised. Atrial pacing and other interventional therapies Maintenance of sinus rhythm can be enhanced by control of intravascular volume in congestive heart failure, avoidance of electrolyte imbalance during diuretic therapy, prevention of coronary ischemia, and judicious use of antiarrhythmic agents.
Atrial pacing can be very effective in preventing bradycardia-mediated atrial fibrillation.
For patients with highly symptomatic paroxysms of atrial fibrillation, which frequently recur despite the use of antiarrhythmic medications, there are new interventional therapies, such as the atrial maze procedure. In this procedure, linear scars are created in the atria either by surgical incisions or catheter ablations. The scars create discriminate routes that enable the depolarization wavefront to propagate from the sinus node to both atria and the atrioventricular node. Sinus rhythm and atrial transport are preserved. Patients in this symptom category are also candidates for use of implantable atrial defibrillators, which are currently undergoing Food and Drug Administration trials.