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Title: Device therapy for the management of symptoms in atrial fibrillation
Author: Silberbauer , John Christian
Awarding Body: St George's, University of London
Current Institution: St George's, University of London
Date of Award: 2012
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Atrial fibrillation is the commonest clinical arrhythmia and places a considerable burden on health services, patient wellbeing and survival. Many strategies have been implemented to treat this condition using such diverse approaches as pharmacological, device, ablative and hybrid therapies. However, as yet there is no panacea for this heterogeneous condition and thus there is active on-going research in each of these fields. The aim of this thesis is to investigate the potential benefits of selected device therapies in the management of symptoms in patients with atrial fibrillation. This thesis commences with a historical review of device therapy for atrial fibrillation. A methodological chapter discusses pacemaker analytical processes and the development of echocardiographic tools for assessing ventricular synchrony during exercise. Original work using third generation anti-AF preventive pacIng algorithms and their impact on disea'se and symptoms is examined. This IS followed by an assessment of the sensing accuracy of modern pacemakers. The device-derived electrophysiological factors are then compared to patient symptoms to isolate predictors of symptomatic status for individual atrial fibrillation episodes. The confounding problem of ventricular pacing is examined for an adverse effect on paroxysmal atrial fibrillation. The next chapter examines the use of an impedance-based rate response sensor in the right ventricular high septum. The final study describes an assessment of right ventricular apical versus high septal pacing in 'ablate and pace' patients with persistent AF uSIng cardiopulmonary and symptomatic assessments. The thesis concludes with the principal findings and a discussion on directions for future research in this field.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available