(Circulation. 1999;99:195-197.)
© 1999 American Heart Association, Inc.
Editorial |
Catheter Ablation of Cardiac Arrhythmias
Usually Cure, but Complications May Occur
From the Department of Cardiology, Academic Hospital Maastricht, Netherlands.
Correspondence to Hein J.J. Wellens, MD, Department of Cardiology, Academic Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, Netherlands.
Key Words: Editorials • catheter ablation • arrhythmia
In cardiology, our ability to cure is rare. When cardiac disease is diagnosed, most of our treatments are palliative. They may remove or diminish complaints and prolong life but usually will not be able to stop the disease process. Cure is possible, however, in the patient suffering from a tachycardia in an otherwise normal heart. In that patient, we can locate the site of abnormal impulse formation or a critical part of the tachycardia pathway by cardiac activation mapping during the arrhythmia. Through the same or another catheter, radiofrequency (RF) energy can be applied to that area, resulting in destruction of a few millimeters of critical tissue and cure of the patient. That technique has been with us now for a decade.1 2 3 4 During that decade, RF energy applied through a catheter has been shown to be very effective in different types of supraventricular tachycardia.
A method can be effective, but its use may be limited because of complications. The key question, therefore, is, how safe is RF catheter ablation in the treatment of patients with arrhythmias? Certain risks are associated with RF ablation. They include the general risks of any cardiac catheterization, such as thromboembolic complications, infection, bleeding, cardiac perforation with or without cardiac tamponade, valvular damage, and radiation damage. In addition, specific risks are related to the ablation procedure itself.
To abolish the substrate of an arrhythmia, a small area
of myocardial necrosis is necessary. It is difficult, however, to
assess in vivo the amount of tissue destroyed by
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