The current status of ablation of cardiac conduction tissue and ectopic myocardial foci by transvenous electrical discharges

Ablation of AV nodal/His bundle conduction by fulgurative electrical discharges has revolutionized the management of refractory supraventricular tachycardias of any type which requires AV conduction over the normal anatomical pathways. The success and safety of the technique is such that it has eclipsed operative ablation of AV conduction. It is increasingly clear that both anomalous pathway conduction and ventricular tachycardia foci may be destroyed by the technique of fulguration and preliminary evidence suggests that certain types of atrial foci may also be susceptible to this method of ablation. Development of purpose-designed electrodes for delivery of the discharges is likely to reduce maximum energy requirements and increase the safety of fulguration.