[Ablative methods, therapeutic alternative to medical treatment for junctional tachycardia]

The clinical syndrome corresponding to junctional tachycardia is generally known as Bouveret's disease, but actually corresponds to two quite separate entities: 1) tachycardia related to a secondary atrioventricular pathway or Kent bundle; 2) intranodal tachycardia arising in the atrio-ventricular node. Until recently, anti-arrhythmics were used to treat most of the cases of accessory pathways. If this was unsuccessful or if the anti-arrhythmics induced adverse effects and in life-threatening cases affecting Kent bundles, surgical section was sometimes proposed, carrying a non-negligible risk of morbidity and mortality. Intranodal arrhythmia is not a serious, but may call for prophylactic antiarrhythmic treatment if it becomes too frequent and disabling. Before the advent of ablative treatment, there was no satisfactory alternative to antiarrhythmic treatment. Ablation of the accessory pathways or selection ablation of the slow pathway of the atrio-ventricular node (sometimes of the rapid pathway) is not achieved by applying a high-frequency current (radiofrequency), which has virtually replaced fulguration (destruction using a modified electrical current). In both types of tachycardia, a cure is obtained in 90% of cases with a low incidence of complications and virtually no risk of mortality, which contrasts favorably with long-term antiarrhythmic treatment (or surgical section of Kent bundles), which justifies the large-scale development of radiofrequency ablation.