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[Treatment of arrhythmia by intracardiac electrocoagulation]
Insights
Catheter ablation effectively treats refractory supraventricular arrhythmias by targeting pathways like the His bundle. While successful for many, His bundle ablation often requires pacemakers, and outcomes for ventricular arrhythmias require further study.
Area of Science:
- Electrophysiology
- Cardiology
- Medical Devices
Context:
- Refractory arrhythmias pose significant clinical challenges.
- Catheter ablation emerged as a novel therapeutic approach.
- Limited data existed on its efficacy and safety for diverse arrhythmia types.
Purpose:
- To evaluate the effectiveness and safety of catheter ablation for refractory arrhythmias.
- To assess outcomes based on the specific ablated cardiac pathway.
- To determine the feasibility of catheter ablation for supraventricular and ventricular arrhythmias.
Summary:
- Twelve patients underwent catheter ablation for refractory arrhythmias, targeting the His bundle (8 patients), accessory pathways (3), or ventricular circuits (1).
- His bundle ablation resulted in heart block in most cases, often necessitating pacemakers. Accessory pathway ablation showed mixed results.
- One patient with ventricular tachycardia remained free of recurrence. Mean follow-up was 12 months with minimal complications.
Impact:
- Catheter ablation is a promising treatment for refractory supraventricular tachyarrhythmias.
- Further research is needed to establish its role in managing ventricular arrhythmias.
- The procedure demonstrates a favorable safety profile with potential for significant patient benefit.
Abstract:
Since July 1982, 12 patients have undergone catheter ablation for refractory arrhythmias. The ablated pathway was the His bundle in 8 patients, an accessory pathway in 3 patients and a ventricular reentrant circuit in 1 patient. The 8 patients in whom the His bundle was ablated comprised 3 cases of atrial flutter, 3 cases of atrial fibrillation, 1 case of atrio-ventricular tachycardia and 1 case of junctional reentrant tachycardia. Results were complete heart block in 6 of these cases, right bundle branch block and first degree a-v block in 1 case and first degree a-v block in the last case. A pacemaker was implanted in 7 patients. The total amount of energy used varied from 50 to 400 joules. In none of these 3 patients did tachyarrhythmia recur. The 3 cases with ablation of the accessory pathway comprised one success, one partial success and one failure. The energy used was 60 to 100 joules. The patient treated for ventricular tachycardia has had no new episodes of tachycardia 4 months after the procedure. The energy used was 200 joules. The mean follow-up for the 12 patients is 12 +/- 7 months. Apart from 2 episodes of thrombophlebitis, no serious complication was noted. Catheter ablation technique is a new and effective treatment for refractory supraventricular tachyarrhythmias. Concerning ventricular arrhythmias, our experience is not sufficient to allow conclusions to be drawn.