Catheter ablation

Radiofrequency catheter ablation Procedure during which radiofrequency energy is delivered through a catheter positioned at the atrioventricular node of the heart for the purpose of destroying one pathway of a reentrant circuit. 

Transcutaneous catheter ablation using radioffequency current on the PSVT substrate should be considered in any patient who would have... 

This arrhythmia usually occurs in young people and preponderantly in men. The electrocardiogram often shows right bundle branch block with left axis deviation (superior axis deviation). This type of VT is often sensitive to verapamil or other calcium channel blockers, but not to /3-blockers. Radiofrequency catheter ablation may be helpful to abolish it. 

Exercise-related VT frequently arises from the right ventricular outflow tract and may be easily evaluated by catheter mapping in an electrophysiology laboratory. The treatment of first choice for chronic therapy of this arrhythmia has been -blockers, but radiofrequency catheter ablation should also be considered. 

Arrhythmias can be treated with the drugs discussed in this chapter and with nonpharmacologic therapies such as pacemakers, cardioversion, catheter ablation, and surgery. This chapter describes the pharmacology of drugs that suppress arrhythmias by a direct action on the cardiac cell membrane. Other modes of therapy are discussed briefly (see The Nonpharmacologic Therapy of Cardiac Arrhythmias). 

Morady F Catheter ablation of supraventricular arrhythmias State of the art. J Cardiovasc Electrophysiol 2004 15 124. [PMID 15028093]... 

Marine JE, Dong J, Calkins H. Catheter ablation therapy for atrial fibrillation. Prog Cardiovasc Dis. 2005 48 178-192. 

Arrhythmias can be treated with the drugs discussed in this chapter and with nonpharmacologic therapies such as pacemakers, cardioversion, catheter ablation, and surgery. This chapter describes... 

The treatment of AF entered a new era after the publication of the landmark observations of Haissaguerre et al (19). Both segmental ostial catheter ablation (20) and left atrial encircling ablation of the pulmonary veins (PVs) (21) have been reported to be successful in the treatment of AF Radiofrequency (RF) ablation is a highly effective therapeutic approach in the treatment of typical isthmus- dependent AFL (22). 

RF catheter ablation is complicated by thromboembolism in about 0.6% of patients (23). The risk of stroke from RF ablation may be higher in paroxysmal AF patients with prior TIA (24). As reflected by elevated plasma D-dimer levels, RF ablation has a thrombogenic effect that persists through the first 48 hours after the procedure (25). Activation of the coagulation cascade in RF ablation procedures is not related to the delivery of RF energy, but is related to the placement of intravascular catheters and to the duration of the ablation procedure (26,27). Furthermore, RF lesions themselves have been shown to be thrombogenic (28). The risk of a thromboembolic complication is higher for left-sided ablations... 

Zhou L, et al, Thromboembolic complications of cardiac radiofrequency catheter ablation a review of the reported incidence, pathogenesis and current research directions. J Cardiovasc Electrophysiol 1999 10(4) 61 I —620. 

Anfinsen OG, et al, The activation of platelet function, coagulation, and fibrinolysis during radiofrequency catheter ablation... 

Khairy R et al, Lower incidence of thrombus formation with cryoenergy versus radiofrequency catheter ablation. Circulation 2003 107( I 5) 2045-2050. 

Anfinsen OG, et al. When should heparin preferably be administered during radiofrequency catheter ablation Pacing Clin Electrophysiol 2001 24(I) 5-I2. 

Gronefeld GC, et al. Thromboembolic risk of patients referred for radiofrequency catheter ablation of typical atrial flutter without prior appropriate anticoagulation therapy. Pacing Clin Electrophysiol 2003 26(l ft 2)323-327. 

Sparks PB, et al. Left atrial "stunning following radiofrequency catheter ablation of chronic atrial flutter. J Am Coll Cardiol I 998 32(2) 468-475,... 

Scheinman M, et al. NASPE policy statement on catheter ablation personnel, policy, procedures, and therapeutic recommendations, Pacing Clin Electrophysiol 2003 26(3) 789—799. 

Haissaguerre M, etal, Electrophysiological end point for catheter ablation of atrial fibrillation initiated from multiple pulmonary venous foci, Circulation 2000 101 (12) 1409— 1417. 

Amiodarone has been reported to cause atrial flutter in 10 patients who had been given it for paroxysmal atrial fibrillation (56). In nine of those the atrial flutter was successfully treated by catheter ablation. However, during a mean follow-up period of 8 months after ablation, atrial fibrillation occurred in two patients who had continued to take amiodarone this was a lower rate of recurrence than in patients in whom atrial flutter was not associated with amiodarone. The authors therefore suggested that in patients with atrial flutter secondary to amiodarone given for atrial fibrillation, catheter ablation allows continuation of amiodarone therapy. 

Reithmann C, Hoffmann E, Spitzlberger G, Dorwarth U, Gerth A, Remp T, Steinbeck G. Catheter ablation of atrial flutter due to amiodarone therapy for paroxysmal atrial fibrillation. Eur Heart J 2000 21(7) 565-72. 

Tai CT, Chiang CE, Lee SH, Chen YJ, Yu WC, Feng AN, Ding YA, Chang MS, Chen SA. Persistent atrial flutter in patients treated for atrial fibrillation with amiodarone and propafenone electrophysiologic characteristics, radiofrequency catheter ablation, and risk prediction. J Cardiovasc Electrophysiol 1999 10(9) 1180-7. 

Yamada T, Doppalapudi H, Mcelderry HT et al (2010) Idiopathic ventricular arrhythmias originating from the papillary muscles in the left ventricle prevalence, electrocardiographic and electrophysiological characteristics, and results of the radiofrequency catheter ablation. J Cardiovasc Electrophysiol 21(1 ) 62-69... 

Eischer B, Haissaguerre M, Gatrigues S, et al. Radiofrequency catheter ablation of common atrial flutter in 80 patients. J Am Coll Cardiol 1995 25 1365-1372. 

Jackman WM, Wang Z, Eriday KJ, et al. Catheter ablation of accessory atrioventricular pathways (Wolff-Parkinson-White syndrome) by radiofrequency current. N Engl J Med 1991 324 1605-1611. 

Scheinman MM. Radiofrequency catheter ablation for patients with supraventricular tachycardia. PACE 1993 16 671-679. 

Rate Versus Rhythm Control 100 Pathophysiology of Atrial Fibrillation 101 Autonomic Effects in Atrial Fibrillation 101 Atrial Remodeling in Atrial Fibrillation 102 History of Catheter Ablation in Atrial Fibrillation 104... 

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