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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