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[High frequency current catheter ablation in treatment of supraventricular and atrioventricular tachycardia]
G Hindricks1, H Kottkamp, S Willems
1Medizinische Klinik und Poliklinik, Universitätsklinik Münster.
Insights
Radiofrequency catheter ablation is a highly effective treatment for supraventricular tachycardias, with success rates over 90%. This minimally invasive procedure offers a curative option for various arrhythmias, with expanding indications for future use.
Area of Science:
- Electrophysiology
- Cardiovascular Medicine
- Interventional Cardiology
Context:
- Radiofrequency catheter ablation is a primary treatment for atrioventricular nodal reentrant tachycardia, atrioventricular tachycardia with accessory pathways, and AV-junction ablation.
- Success rates for these indications exceed 90%, with acute complications in 2-5% of patients.
Purpose:
- To review the efficacy and safety of radiofrequency catheter ablation for supraventricular tachycardias.
- To discuss the varying complication rates associated with different ablation techniques, particularly anterior vs. inferior approaches for AV nodal modification.
Summary:
- Ablation of accessory pathways and AV-junction has high success rates (>90%) and low complication rates (2-5%).
- AV nodal modification for AV nodal reentrant tachycardia shows technique-dependent complication risks (4-8% for fast pathway vs. 2% for slow pathway).
- Recurrence rates are low for AV-junction ablation but around 10% for AV nodal modification or accessory pathway ablation.
Impact:
- Radiofrequency ablation is increasingly indicated for various supraventricular tachycardias, including rarer types like atrial flutter.
- Future applications may include slowing ventricular rates in atrial fibrillation and potentially curing most supraventricular tachycardias, excluding atrial fibrillation.
- The high success rate and low complication profile support expanding the use of radiofrequency ablation for supraventricular tachycardias.
Abstract:
Radiofrequency catheter ablation has been established as a first line therapy for the curative treatment of patients with atrioventricular nodal reentrant tachycardia and atrioventricular tachycardia encompassing accessory pathways as well as for ablation of the "normal" AV-junction. For these indications, the success rates exceed 90%. Acute complications during ablation of accessory pathway and ablation of the "normal" AV-junction occur in approximately 2-5% of patients treated. The incidence of complications during modification of the atrioventricular node to cure AV-nodal reentrant tachycardias clearly depends on the ablation technique used. The anterior approach with ablation of the so-called "fast pathway" carries a significantly higher risk of complete AV-block when compared to the inferior approach (so-called "slow pathway ablation") (approximately 4-8% vs. 2%). Arrhythmia recurrence after successful ablation of the "normal" AV-junction occurs only rarely, while the recurrence rate after modification of the AV-node or ablation of accessory pathway is approximately 10% during long-term follow-up. Recently, it has been shown that other, rare types of supraventricular tachycardia (sinus-atrial reentrant tachycardia, ectopic atrial tachycardia, human type I atrial flutter) can also be successfully ablated using radiofrequency current. In addition, first clinical results indicate that modification of anterograde AV-nodal conduction properties in patients with atrial fibrillation and fast ventricular rate by radiofrequency application to postero- and midseptal sites might be a useful therapeutic tool to slow ventricular rate. Because of the high success-rate and the relative low incidence of severe procedure related complications, the indications of radiofrequency ablation procedures for the treatment of supraventricular tachycardias will be extended in the future. In addition, it might be reasonable to expect that during the next years, all types of supraventricular tachycardia, except atrial fibrillation, can be targeted and cured by radiofrequency ablation in the majority of cases.