Radiofrequency catheter ablation: a new frontier in interventional cardiology.

The development of non-pharmacological approaches for controlling cardiac arrhy- thmias reflects the many limitations of longterm antiarrhythmic drug therapy. These include poor patient compliance, frequent treatment failures or side effects or both, and a small but definite risk of life-threatening toxicity or proarrhythmia. Antiarrhythmic surgery has proved highly effective in many arrhythmias but it is expensive, causes con- siderable discomfort, and is associated with a definite incidence of morbidity and mortality. Curative ablation of arrhythmia substrates by catheter-based techniques avoids many of these problems and is far more acceptable to patients and physicians. In 1982, Gallagher and Scheinman separately described success- ful closed chest ablation of the atrioventricular junction by transcatheter delivery of high energy unmodified DC shocks to the His bundle region for the treatment of patients with drug-refractory supraventricular arrhyth- mias."2This comparatively crude approach committed the patient to a permanent pace- maker and was associated with significant risk of barotrauma, but nevertheless its advent marked the beginning of a new era of inter- ventional electrophysiology. Since 1982 improvements in catheter design, power sources, and mapping techniques have trans- formed catheter ablation from an investigational procedure into an indispensable therapeutic tool that has supplanted surgery and antitachycardia pacing in the manage- ment of the Wolff-Parkinson-White syndrome and junctional tachycardias and is also being applied with increasing success to various other arrhythmias including atrial flutter, ectopic atrial tachycardia, and some cases of ventricular tachycardia.