Transcatheter ablation of cardiac tissue: advantages and disadvantages of different ablative techniques

Transcatheter ablation techniques are emerging as an alternative therapeutical tool in the management of cardiac arrhythmias. Catheter ablation was initially introduced as the last resort to ablate the atrioventricular nodal conduction in patients with atrial fibrillation and uncontrolled ventricular response and in patients with drug refractory ventricular tachycardias. Direct current energy was used as the sole source of energy, but because of potential significant complications and early and late mortality, presumably mostly due to ventricular tachyarrhythmias, other sources of energy were sought. Radiofrequency current which does not produce barotrauma and does not require general anesthesia rapidly replaced direct current ablation in many centers. Early results with radiofrequency current ablation of the atrioventricular node and accessory atrioventricular pathways are very encouraging. The results of radiofrequency as well as direct current ablation for atrial flutter, atrial tachycardia and ventricular tachycardia, where the components of reentry circuit are less defined, are not as favorable as those of AV junctional tachycardias. However, improvement of catheter and generatory technology and better understanding of the mechanisms of ventricular tachycardias and characteristics of the target site will enhance the results of catheter ablation in ventricular tachcardias. The procedures are still considered investigational, and mostly done by very experienced groups at tertiary referral hospitals with surgical teams available in case of serious complications. Larger patient populations and longer follow-up periods are required before these techniques expand to community hospitals and to patients with minimal symptoms or asymptomatic individuals as a prophylaxis therapy.