Author + information
- Hans Kottkamp, MD*,* (, )
- Gerhard Hindricks, MD*,
- Gerhard Schuler, MD* and
- Friedrich-Wilhelm Mohr, MD*
- ↵*Reprint requests and correspondence:
Dr. Hans Kottkamp, University of Leipzig Heart Center, Department of Cardiology, Struempellstrasse 39, D-04289 Leipzig, Germany.
We would like to thank Dr. Bonanomi and colleagues for their interest in our work and for their thorough comments. The spectrum of patients with atrial fibrillation (AF) is very wide and varies from the 35-year-old manager with recurrent weekly paroxysms of AF resistant to antiarrhythmic drugs and severe symptoms to the 75-year-old man with hypertension and concomitant asymptomatic rate-controlled AF. Effective and safe treatment strategies are available for many patients, and these often consist of beta-blockers for rate control plus oral anticoagulation for prevention of thromboembolic events. However, a uniformly effective and safe treatment strategy for all patients with AF does not exist owing to the diversity of patients with respect to symptoms, age, underlying heart disease, responsiveness to drugs, and so on.
Curativetreatment of AF with the potentiality for widespread clinical application remains one of the main challenges of interventional electrophysiology. Given the complex electrophysiologic nature of AF, interventional treatment strategies target at pathophysiologic cornerstones of AF (i.e., the initiating or the maintaining factors). Surgical series from Cox et al. (1)and others as well as catheter ablation studies from Haissaguerre et al. (2)and others have all substantially contributed to both the understanding of the pathophysiology of AF and the development of clinical treatment strategies for our patients. In our recently published study (3), a new specific concept of intraoperative radiofrequency ablation was described. Dr. Bonanomi and Colleagues addressed the important question of thromboembolic events. In our published series of 70 patients with AF, normalized left atrial mechanical transport function could be documented in all patients with postoperative sinus rhythm during follow-up, and no thromboembolic complications were observed (3). Clearly, larger patient cohorts and longer follow-up periods in studies specifically addressing the incidence of thromboembolic complications and the role of oral anticoagulation after interventional treatment of AF will be necessary to clarify this issue.
Finally, Dr. Bonanomi and colleagues also mentioned preliminary reports on percutaneous occlusion and thoracoscopic amputation of the left atrial appendage. Again, all these clinical studies contribute to the puzzle. We are convinced, however, that the futuregold standard of interventional treatment of AF will restore sinus rhythm with normalized atrial mechanical function.
- American College of Cardiology Foundation