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ELECTROPHYSIOLOGY
Radiofrequency catheter ablation of supraventricular arrhythmias
  1. Hugh Calkins
  1. Johns Hopkins Hospital, Baltimore, Maryland, USA
  1. Hugh Calkins, MD, Professor of Medicine, The Johns Hopkins Hospital, 592 Carnegie, 600 North Wolfe Street, Baltimore, Maryland 21287-6568, USAhcalkins{at}jhmi.edu

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For most types of supraventricular arrhythmias medical treatment with antiarrythmic drugs is not completely effective. In addition to poor or sporadic efficacy, such drugs can be associated with a number of bothersome and even fatal side effects (although rarely), proarrhythmia, cost, and inconvenience. It is for these reasons that non-pharmacologic interventions, initially using a surgical approach and more recently utilising catheter ablation, have played an increasingly important role in the management of cardiac arrhythmias. Catheter ablation can be defined as the use of an electrode catheter to destroy small areas of myocardial tissue or conduction system, or both, that are critical to the initiation or maintenance of cardiac arrhythmias. Arrhythmias most likely to be amenable to cure with catheter ablation are those which have a focal origin or involve a narrow, anatomically defined isthmus.

Key points

  • Catheter ablation is now considered as a first line alternative to pharmacologic therapy for the treatment of focal atrial tachycardia, atrioventricular nodal re-entrant tachycardia, and atrioventricular reciprocating tachycardia associated with an accessory pathway

  • Catheter ablation of the atrioventricular junction is also commonly used to control the ventricular response in patients with atrial fibrillation

  • Arrhythmias recur following 3–5% of successful catheter ablation procedures

  • Recurrences generally present within the first three months following an ablation procedure

  • A repeat ablation procedure is associated with a very high likelihood of long term success

Over the past two decades, catheter ablation has evolved from a highly experimental technique to first line treatment for many cardiac arrhythmias. Before 1989, catheter ablation was performed primarily with high energy direct current (DC) shocks. More recently, DC energy has been replaced with radiofrequency energy as the preferred energy source during catheter ablation procedures.

This article reviews the current state of knowledge about the technique, indications, and results of radiofrequency catheter ablation for the …

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