Treatment of Atrial Fibrillation in Patients Affected by Sick Sinus Syndrome: Role of Prevention and Antitachycardia Pacing Algorithms. Preliminary Results from PITAGORA Study

With a prevalence rising with age from 0.05% at age 25-35 years to more than 5% among people aged 69 years or more, atrial fibrillation (AF) and in general atrial tachyarrhythmias (AT) are now the single most common sustained arrhythmia [1]. Once considered a benign disease, AF is increasingly being recognized as a significant cause of morbidity and mortality. AT can be treated by a vast array of pharmaceutical and nonpharmacological therapies, suggest­ing that no single treatment is sufficiently simple, successful, and cheap to exclude other therapies. Many new therapies are presently being developed, among which are electrical therapies designed to prevent and convert AT. Clinical experience indicates that monotherapeutic approaches (drug, abla­tion, or device) are often associated with unsatisfactory results in the treat­ment of AT patients [1-12]. Because all therapies have poor efficacy when con­sidered alone, interest in the role of combinations of therapies (hybrid thera­py) has recently increased. The rationale underlying hybrid therapy is that a combination of modalities of intervention in AT might have a synergistic effect, with the efficacy of each intervention building upon that of the others [12]. At present this concept is being considered particularly in the prevention of AT recurrence, but hybrid therapy has also been utilized both in facilitating restoration to sinus rhythm and in control of heart rate.