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  Česky / Czech version Prakt. Lék., 79, 1999, No. 5, p. 274-282.
 
Radiofrequency Catheter Ablation of Cardiac Arrhythmias: A Revolution in Modern Cardiology 
KAUTZNER J. 

 


Summary:

       Radiofrequency catheter ablation is a recently developed technique for achieving cure of a broad spectrum of cardiac arrhythmias. Since its introduction into clinical practice in 1982, it has evolved from a therapy of a last resort for patients, whose tachyarrhythmias were refractory to medical therapy, into treatment of choice for patients with supraventricular tachycardias and some with ventricular tachycardias. The increasing popularity and success of this technique reflect primarily important advances made in following: 1. our understanding of the underlying mechanism 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 radiofrequency catheter ablation, its overall efficacy, complication rate and indications. High success rate of radiofreqency catheter ablation allows to cure permanently high proportion (in the range of 95-100 %) of patients with the most frequent supraventricular tachyarrhythmias such as atrioventricular nodal re-entrant tachycardias and/or atrioventricular re-entrant tachycardias in the presence of accessory pathways. For other supraventricular arrhythmias, the reported succes rate of selective catheter ablation is slightly lower and reaches 80-90 % on average. The only supraventricular tachyarrhythmias that cannot yet be cured selectively comprise atrial fibrillation 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 the pacemaker may offer substantial relief of the symptoms refractory to medical treatment. The overall efficacy of radiofrequency catheter ablation in treatment of ventricular tachycardias is still lower, reaching 60-70 % in those ventricular tachycardias after myocardial infarction which are haemodynamically tolerated and can be mapped. On the other hand, idiopathic ventricular tachycardias in the absence of organic heart disease may be cured successfully in the vast majority of patients. Despite its invasive nature, the complication rate of the method is generally very 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 supraventricular tachyarrhythmias and selected ventricular tachyarrhythmias.

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

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