Non-pharmacological treatment of supraventricular arrhythmias

In recent years the recognition of toxicity and relative ineffectiveness of antiarrhythmic drugs in the management of arrhythmias has led to the development of non-pharmacological approaches. In the setting of supraventricular arrhythmias, such non-pharmacological approaches include preventative pacing, atrial defibrillation, surgery and radiofrequency catheter ablation. Success rates for catheter ablation exceeding 90% are expected in A-V nodal reentrant tachycardia. A-V reentry due to concealed or manifest bypass tracts, and incessant atrial tachycardias. Success rates in the management of atrial flutter are rapidly approaching this. Atrial fibrillation remains the main problem for which pharmacological therapy may still be useful. New preventative pacing modes, automatic atrial defibrillation, and perhaps surgical or radiofrequency procedures to limit the ability to sustain atrial fibrillation are on the horizon.