[High frequency current catheter ablation in ventricular tachycardia]

Area of Science:

• Electrophysiology
• Cardiovascular Medicine
• Interventional Cardiology

Context:

• Catheter ablation has become a primary non-pharmacological treatment for atrioventricular nodal reentrant tachycardia and accessory pathway-related atrioventricular tachycardia since 1982.
• Early ablative techniques using direct current led to severe complications, prompting a shift to radiofrequency (RF) current catheter ablation.

Purpose:

• To evaluate the efficacy and current status of radiofrequency (RF) current catheter ablation as a therapeutic option for various forms of ventricular tachycardia.
• To identify patient subgroups where RF catheter ablation shows limitations and requires further technical and diagnostic improvements.

Summary:

• RF catheter ablation demonstrates high efficacy (>80%) in idiopathic ventricular tachycardia and bundle-branch reentrant tachycardia, with a relatively high acute success rate in incessant ventricular tachycardia.
• The procedure is less effective in patients with drug-resistant, chronic, sustained ventricular tachycardia post-myocardial infarction or with dilated cardiomyopathy.
• Efficacy is significantly influenced by the presence and type of organic heart disease and the underlying mechanisms of ventricular tachycardia.

Impact:

• RF catheter ablation represents a significant advancement in non-pharmacological treatment for ventricular tachycardia, offering a promising alternative to antiarrhythmic drugs.
• Further research is crucial to refine localization criteria and techniques for ventricular tachycardia ablation, particularly in patients with structural heart disease.
• Long-term outcome data are limited, underscoring the experimental nature of RF catheter ablation for certain ventricular tachycardia types.