Current role of catheter ablative procedures in patients with cardiac arrhythmias. A report for health professionals from the Subcommittee on Electrocardiography and Electrophysiology, American Heart Association.

Abstract

Catheter ablative techniques have assumed an increasingly important role in the treatment of patients with drug-refractory cardiac arrhythmias. Catheter ablation of the AV junction is considered the procedure of choice for management of patients without bypass tracts with drug-resistant supraventricular arrhythmias. Catheter techniques have been used with increasing frequency in attempts to ablate accessory AV tracts. These techniques currently appear to be less effective than surgical techniques but involve less morbidity and expense. In some centers, accessory pathway ablation using catheter techniques is the procedure of first choice in selected patients with drug-refractory tachycardia mediated by an accessory pathway. Catheter ablation of ventricular tachycardia should be reserved for patients with mappable ventricular tachycardia who are not candidates for cardiac electrosurgery or insertion of an automatic defibrillator. The development of more flexible catheters and more manageable energy delivery systems holds promise for more effective catheter techniques.

Laser photoablation of experimental post-infarction ventricular tachycardia guided by three dimensional activation mapping

“…Radiofrequency catheter ablation lesion is usually less than 1 cm 2 in surface size, non-transmural and discreet [22][23]. DC ablation, which involves other risks, can create transmural lesions with a 2.0-3.4 cm 2 surface size [24]. These lesions may be too small to ablate the arrhythmogenic tissues.…”

Chinese expert consensus on the construction of the fluoroless cardiac electrophysiology laboratory and related techniques

“…Based on the current clinical practice experience, this expert task force considers that the following conditions are not suitable for performing the procedure in the fluoroless cardiac EP Lab (1) known vascular access abnormalities, including but not limited to femoral/iliac vein/inferior vena cava (IVC) tortuosity, stenosis, occlusion, etc. ; cardiovascular system malformations or congenital transposition of internal organs, etc.…”

“…In the 1980s, transcatheter radiofrequency ablation was introduced for the treatment of tachyarrhythmias. 1 Traditional catheter ablation is performed under X-ray guidance. Although X-ray visualization can provide information such as the cardiac silhouette and catheter position, it is limited to a two-dimensional plane, cannot reveal intracardiac anatomy, and is a real-time imaging modality only when fluoroscopy is activated.…”

Laser versus Radiofrequency Catheter Ablation of Ventricular Myocardium in Dogs: A Comparative Test

“…Despite disap pointing results with conventional drug treatment, impor tant advances have been made in the development of alternative treatment modalities, including surgery [2,3], implantation of a cardioverter defibrillator [4] and cathe ter ablation. While catheter ablation has been very suc cessful in the treatment of supraventricular tachycardia [5,6], catheter ablation of ventricular tachycardia associ ated with myocardial infarction has been reported to be successful in only 18-50% of the survivors [7][8][9].…”