Radiofrequency Catheter Ablation for Cardiac Tachyarrhythmias

PURPOSE: To review the radiofrequency ablation method, describe the technique, and discuss the indications, results, and limitations of its use in patients with cardiac tachyarrhythmias. DATA SOURCES: Peer-reviewed reports in the literature by clinical investigators who use radiofrequency catheter ablation as identified by a MEDLINE search and our own experience with this intervention in 214 patients with cardiac tachyarrhythmias. STUDY SELECTION: All articles reporting results of radiofrequency ablation for cardiac tachyarrhythmias and articles describing the ablation technique or comparing it with direct-current or surgical methods. RESULTS OF DATA SYNTHESIS: Percutaneous catheter ablation of cardiac arrhythmias using high-voltage, direct current was limited by a high complication rate and a need for general anesthesia. This method was recently replaced by a new safe and efficacious technique using low-voltage, high-frequency (radiofrequency) alternating current. Nonsurgical cure of many supraventricular arrhythmias is now feasible with radio-frequency ablation, especially in patients with accessory pathways or atrioventricular nodal reentrant tachycardia. For these arrhythmias, success rates are greater than 90%. The indications for ablation include preexcitation syndromes, atrioventricular nodal reentrant tachycardia, and other selected atrial and ventricular tachyarrhythmias refractory to antiarrhythmic drug therapy. The efficacy and safety profile of this technique has made it feasible for children as well as adults. CONCLUSIONS: Percutaneous radiofrequency catheter ablation has evolved as a safe and effective method for managing and curing the two most common forms of supraventricular tachycardia: those associated with preexcitation syndromes and atrioventricular nodal reentrant tachycardia. Further studies are needed to determine the efficacy of this method or to evaluate alternative transcatheter techniques in patients with atrial tachycardias and, more importantly, in the large population of patients with ischemic ventricular tachycardia.