Catheter Ablation for Cardiac Arrhythmias
Identifieur interne : 001974 ( Main/Exploration ); précédent : 001973; suivant : 001975Catheter Ablation for Cardiac Arrhythmias
Auteurs : Hugh CalkinsSource :
- Medical Clinics of North America [ 0025-7125 ] ; 2001.
Abstract
For most cardiac arrhythmias, medical therapy with antiarrhythmic drugs is not completely effective. In addition to poor or sporadic efficacy, such drugs can be associated with many bothersome and rarely fatal side effects, proarrhythmia, cost, and inconvenience. For this reason, nonpharmacologic interventions, initially using a surgical approach and more recently with catheter ablation, have played an increasingly important role in the management of cardiac arrhythmias. Catheter ablation involves the use of an electrode catheter to destroy small areas of myocardial tissue or conduction system, or both, that are crucial to the initiation or maintenance of cardiac arrhythmias. Arrhythmias most likely to be amenable to cure with catheter ablation are those that have a focal origin or involve a narrow, anatomically defined isthmus. Since the 1980s, catheter ablation has evolved from a highly experimental technique to first-line therapy for many cardiac arrhythmias. During the 4-year period from 1989 to 1992, the number of patients undergoing catheter ablation procedures in the United States increased more than 30-fold from an estimated 450 procedures in 1989 to 15,000 procedures in 1993.91 This evolution in the role of catheter ablation reflects, in large part, a change in the energy source used during catheter ablation procedures. Before 1989, catheter ablation was performed primarily with high-energy direct-current shocks. Typically a multipolar electrode catheter was positioned in the heart and attached to a standard defibrillator. Under general anesthesia, 360 J of direct-current energy was delivered between the distal electrode and a patch placed on the patient's chest. This energy produced an explosive flash, heat, and increased pressure. Myocardial injury resulted from heat, barotrauma, and direct electric injury. More recently, direct-current energy has been replaced with radiofrequency energy as the preferred energy source during catheter ablation procedures. This article reviews the current state of knowledge about the technique, indications, and results of catheter ablation for the treatment of cardiac arrhythmias.
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DOI: 10.1016/S0025-7125(05)70323-0
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