Treatment of rhythm disorders by endocardial fulguration

The fulguration procedure was originally introduced for the treatment of supraventricular arrhythmias by a pervenous interruption of His bundle conduction. This procedure has been extended to the treatment of almost any cardiac arrhythmia resistant to antiarrhythmic drug therapy. Recent results suggest that ablation could be selectively applied to the site of abnormal conduction. Overall results obtained at the Jean Rostand Hospital are reported for a series of 104 patients ranging in age from 14 to 83 years with atrial, junctional and ventricular tachycardias. The follow-up extends up to 65 months. Clinical efficacy, defined as a control of the arrhythmias by fulguration used alone or in association with drug therapy that was previously ineffective, lead to a success rate ranging from 80 to 85%. Mortality was less than 10% in the worst situation (chronic resistant ventricular tachycardia). Mortality was always related to inappropriate protocols. Therefore, fulguration, which was originally reserved to treat the most difficult cases, is now considered for non-life-threatening but incapacitating arrhythmias. Despite these results the technique is not simple. Fulguration should be performed by groups knowledgeable in electrophysiology and with expertise in high voltage electricity and biophysics.