[Catheter ablation and implantable atrial defibrillators in supraventricular cardiac arrhythmias]

Non-pharmacological tools for treatment of supraventricular tachycardias include radiofrequency catheter ablation, antiarrhythmic surgery, and electrical therapies. Radiofrequency catheter ablation is the first choice in the treatment of symptomatic patients with AV nodal reentrant tachycardias and atrioventricular reentrant tachycardias because of its high success rate and its low complication rate. Furthermore, transvenous radiofrequency catheter ablation may be considered as a curative approach in patients with atrial flutter and in patients with ectopic atrial tachycardias. Whereas the application of radiofrequency catheter ablation for the curative treatment of atrial fibrillation is still experimental, palliative therapy modalities such as AV nodal modification or AV nodal ablation may be performed in patients with drug refractory atrial fibrillation with rapid ventricular response. The recurrence rate of atrial fibrillation is in the range of 40 to 60% within a year despite antiarrhythmic drug treatment. Internal atrial fibrillation is a safe and effective method for acute termination of atrial fibrillation, especially after unsuccessful external cardioversion. The electrotherapy with the implantable atrial defibrillator should be considered as an alternative approach in patients with symptomatic, long lasting, and drug refractory episodes of atrial fibrillation. This innovative electrotherapeutic tool is currently under clinical evaluation. For the selection of the most appropriate therapy, the risk-benefit-ratio has to be taken into account in each individual patient.