[Endocavitary fulguration. A new method of treating arrhythmia?]

Endocavitary diathermy consists of transmitting the energy of a defibrillator shock to the tip of an intracardiac catheter. The circuit is completed via a neutral plate placed under the patient's back. Energies in the order of 200 to 300 joules produce an electric arc at the catheter tip which causes an abrupt variation in pressure and the creation of a shock wave which modifies the myocardial structures directly in contact with the catheter. This method, which was originally used to treat supraventricular arrhythmias by interrupting the conduction in the His bundle, has recently been extended to the treatment of resistant ventricular tachycardia, and has even been used to interrupt the accessory pathway in certain cases of Wolff-Parkinson-White syndrome. The authors report the basic experimental data and the clinical results obtained with this method in the treatment of 20 cases of arrhythmia, especially in various types of ventricular tachycardia. The very promising results obtained, particularly in cases of ventricular tachycardia, suggest that this is a radical method which can be extended to patients unable to support a surgical operation. Although the follow-up period is only short, these results are encouraging. They confirm the basic principle of diathermy in the treatment of supraventricular tachycardia by interruption of the conduction in the His bundle and for the radical treatment of chronic ventricular tachycardia unresponsive to medical treatment. However, a longer follow-up period is required before we can demonstrate the long term effectiveness of this new therapeutic method.