New horizons in catheter ablation

Catheter ablation has evolved into the dominant therapeutic modality in the treatment of a variety of arrhythmias, particularly supraventricular arrhythmias with the mechanisms of atrioventricular (AV) nodal reentry and AV reciprocating tachycardia via an accessory pathway. The mode of catheter ablation used in the great majority of cases is radiofrequency (RF) catheter ablation. This technology is well-suited for the above arrhythmias because the targets and the RF lesions are both small and discrete. Using temperature monitoring may improve the outcome of these procedures by decreasing procedure time and incidence of coagulum formation on the catheter after a sudden rise in electrical impedance. New RF catheter designs and new modalities of creating catheter-induced focal myocardial injury will allow operators to have improved success with the ablation of less approachable arrhythmias, including atrial flutter and reentrant ventricular tachycardia. Studies are currently underway to create a catheter based ''maze'' procedure for the treatment of atrial fibrillation. As techniques and technologies evolve, a greater proportion of patients with symptomatic or threatening arrhythmias may be approached with catheter ablation as a curative or palliative procedure.