Symptomatic
atrial fibrillation is often treated with
antiarrhythmic drugs. Responsiveness is poor and adverse effects common. Nonpharmacologic treatments consisting of the
Maze procedure and
catheter-based pulmonary vein isolation are highly successful but invasive with complications. Right atrial ablation is relatively simple in comparison. Success ranges between 20% and 80%. Some studies have shown improved response when combined with
antiarrhythmic drugs (AADs). We performed a review of available literature to determine the efficacy of hybrid
therapy in the form of right atrial ablation, AAD with
cardioversion, and pacing in reducing
atrial fibrillation burden. All human studies studying efficacy of right atrial ablation and postablation AAD
therapy in refractory
atrial fibrillation were considered. The primary outcome was reduction of
atrial fibrillation burden. The secondary outcome was significant adverse events. We searched Medline, EMBASE, CINAHL, and Cochrane databases. Data collection, analysis, and selection of studies were done independently by two review authors. We included six studies with variable numbers of participants and outcomes. We defined success of hybrid
therapy as reduced burden of
atrial fibrillation. Total subjects studied was 189, 26% female and 74% male. Average age was 58 years. Left atrial diameter was less than 5 cm and mean ejection fraction was 64%. Mean
atrial fibrillation duration was 3.35 years. Most patients had failed at least two AADs. Hybrid
therapy was successful in 82% patients. All forms of hybrid
therapy consisting of right atrial ablation and AAD
therapy seem to be reasonably effective in relief of symptoms from refractory
atrial fibrillation with minimal side effects; however, much larger randomized trials need to be performed before a significant superiority of any one may be established.