Radiofrequency catheter ablation of the substrate of cardiac arrhythmias

pp 441-460

Abstract

This report presents results of seven years experience with radiofrequency catheter ablation at the University Hospital of Utrecht, The Netherlands. During this period, a total of 448 patients were treated for a variety of supraventricular and ventricular tachyarrhythmias. Success rates were excellent in patients with accessory atrioventricular pathways and atrioventricular nodal reentry tachycardia, at 95% and 93% respectively. Incidence of inadvertant total auriculoventricular block in the latter group was low: 5.4% for the anterior approach and 1.5% for the posterior approach. His bundle ablation was performed predominantly in patients with drug refractory atrial fibrillation, with 100% success. While results were also good in patients with idiopathic ventricular tachycardia, with 5 of 6 patients free of recurrence during drug free follow-up, only 36% of patients with ventricular tachycardia due to underlying structural heart disease were treated successfully. Result demonstrate that radiofrequency ablation is a safe and potentially curative modality in the treatment of patients with arrhythmias originating in or sustained by a circumscript anatomical substrate. On the other hand, the discrete endomyocardial lesions created result in significantly poorer results in patients with large and complex arrhythmogenic substrates. Findings underline the enormous importance of careful target localization and catheter positioning for the successful and rational use of radiofrequency ablation.