Is an atrial defibrillator still an option in treating patients with atrial fibrillation?

Atrial fibrillation (AF) is a common disorder associated with significant morbidities and presents several challenges for the control of symptoms and prevention of long-Term implications. Atrial defibrillators (ADs), used for rhythm control in patients with symptoms refractory to medical therapy, can detect recurrences of the arrhythmia, allow prompt patient-directed treatment, and have the potential to reduce hospitalizations and improve quality of life. The efficacy of this form of therapy is highest in patients with paroxysmal AF, and with the use of a coronary sinus shocking lead. While R-wave synchronized shocks are a prerequisite for a safe use, the procedure is well tolerated and usually not associated with long-Term psychological side effects. Limitations of ADs include acute and chronic complications related to cardiac rhythm device implantation, the requirement in some cases for more than one shock to terminate AF, the discomfort from shocks, as well as the need for sedation to alleviate pain from the shocks. With the ever-expanding role of catheter-based therapies for AF, it seems that the role of ADs in this regard is rather limited.