Catheter electrocoagulation of serious cardiac arrhythmias

During recent years, catheters (originally designed for intracardiac recording and pacing) have been used for purposes of electrocoagulation of the AV junction, accessory pathways, or ventricular tachycardia foci. The experience to date suggests that catheter ablation of the AV junction is a reasonable alternative for patients with drug-refractory supraventricular tachycardia who are deemed candidates for surgical division of the His bundle. Complete or partial success is expected in approximately 85 percent of patients, and thus significant numbers of patients may be spared the morbidity and expense of surgery. The available experience using catheter ablation for accessory pathways is limited, and thus definitive recommendations cannot be made. Early experience suggests that patients with posteroseptal accessory pathways who require surgical intervention may benefit from attempted catheter ablation. Although successful catheter ablation of ventricular tachycardia foci has been reported, technical problems relating to current endocardial mapping techniques, the demonstrated proarrhythmic effects of the shocks in animals, and the very limited clinical experience suggest that this use be considered highly experimental at present.