Recent studies of
atrial fibrillation, or rather "
atrial fibrillations", have been based on focal
atrial fibrillation which seems to be one of the commonest forms of
paroxysmal atrial fibrillation. This observation led to the possibility of ablative
therapy, usually near the pulmonary veins. Technological advances are awaited before a wider diffusion of this
therapy becomes possible. In the field of defibrillation, the MUSTT study demonstrated the value of
implantable defibrillators in the prevention of
sudden death, in this trial in the case of asymptomatic high risk patients after
myocardial infarction, with a decreased ejection fraction and non-sustained
ventricular tachycardia. Two large scale randomised controlled trials (MERIT-HF and CIBIS II) have confirmed the value of betablockers in preventing
sudden death, in patients with moderate or severe
cardiac failure in association with classical treatment by
diuretics,
ACE inhibitors and digitalis. Similarly, for
spironolactone, the
RALES study showed a reduced incidence of
sudden death in
cardiac failure, as its physiopathological modes of action suggested. New techniques of three-dimensional mapping have confirmed their value. Finally, significant progress has been made in the field of genetics of
cardiac arrhythmias, indicating that, in years to come, it will be possible to identify most of the genes responsible for conditions predisposing to arrhythmias.