Tratamiento no farmacológico de la fibrilación auricular. Ablación, cardioversión eléctrica, marcapasos y cierre de la orejuela

This article provides an update on the nonpharmacological treatment of atrial fibrillation. First, the current status of ablation, including indications, techniques and outcomes, is reviewed. Second, the indications for electrical cardioversion, the precautions that have to be taken and the outcomes achievable are summarized. In addition, there is a discussion of the role of pacemakers for heart rate control in two groups of patients with atrial fibrillation: those with permanent atrial fibrillation and those in whom pharmacological control is difficult, such as patients with paroxysmal atrial fibrillation or bradycardia- tachycardia syndrome. Finally, an overview is presented of the devices currently used for left atrial appendage closure in patients with a high thromboembolic risk and a contraindication to oral anticoagulants.