I have the echo hooked up to a Harmony Hub[0], it's a universal remote that controls devices via IR or wifi that the echo can trigger via IFTTT. The Harmony Hub UX is annoyingly overdesigned IMO which makes it more complicated than it should be, but it still works pretty well. I can use it to turn up/down the volume of the tv, hit pause on the Apple TV when I get up to do something, turn on/off the fan if I get hot/cold, etc.
The TV use is pretty neat since it takes so many clicks to navigate those menus. I'm hoping the echo will integrate natively with Apple TV or Fire TV, it would be sweet to be able to say "Alexa, play the latest Game of Thrones" and have it just start.