Radiofrequency Catheter Ablation of Cardiac Arrhythmias: A Revolution in ModernCardiology

Overview

Radiofrequency catheter ablation is a recently developed technique for achieving cure of a broadspectrum of cardiac arrhythmias. Since its introduction into clinical practice in 1982, it hasevolved from a therapy of a last resort for patients, whose tachyarrhythmias were refractory tomedical therapy, into treatment of choice for patients with supraventricular tachycardias andsome with ventricular tachycardias. The increasing popularity and success of this techniquereflect primarily important advances made in following: 1. our understanding of the underlyingmechanism of cardiac arrhythmias, 2. the advent of radiofrequency energy, and 3. improve-ments in the design of ablation catheters. This article reviews basic principles of radiofrequencycatheter ablation, its overall efficacy, complication rate and indications. High success rate ofradiofreqency catheter ablation allows to cure permanently high proportion (in the range of95-100 %) of patients with the most frequent supraventricular tachyarrhythmias such asatrioventricular nodal re-entrant tachycardias and/or atrioventricular re-entrant tachycardiasin the presence of accessory pathways. For other supraventricular arrhythmias, the reportedsucces rate of selective catheter ablation is slightly lower and reaches 80-90 % on average. Theonly supraventricular tachyarrhythmias that cannot yet be cured selectively comprise atrialfibrillation and atypical atrial flutter with a functionally defined re-entrant circuit. However,even in these arrhythmias radiofrequency ablation of the AV junction and implantation of thepacemaker may offer substantial relief of the symptoms refractory to medical treatment. Theoverall efficacy of radiofrequency catheter ablation in treatment of ventricular tachycardias isstill lower, reaching 60-70 % in those ventricular tachycardias after myocardial infarction whichare haemodynamically tolerated and can be mapped. On the other hand, idiopathic ventriculartachycardias in the absence of organic heart disease may be cured successfully in the vastmajority of patients. Despite its invasive nature, the complication rate of the method is generallyvery low and significant complications can be expected at the level of 1-2 %. In conclusion,technique of radiofrequency catheter ablation has launched a revolution in modern cardiology that changed completely our approach to the treatment of the vast majority of supraventriculartachyarrhythmias and selected ventricular tachyarrhythmias.

Key words:
radiofrequency catheter ablation - supraventricular tachycardia - ventriculartachycardia.