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radiofrequency catheter ablation

Indications: 1) AV nodal re-entrant tachycardia (97%)* 2) orthodromic AV reciprocating tachycardia in involving a manifested or concealed pathway (97%)* 3) sustained unifocal atrial tachycardia 4) *AV nodal ablation to create complete heart block in patients with uncontrolled ventricular response to atrial fibrillation (100%)* 5) atrial flutter (90%)* 6) atrial fibrillation (66%) [2,5] (see pulmonary vein isolation) 7) ventricular arrhythmias a) ventricular tachycardia in the absence of structural heart disease b) ventricular tachycardia involving the conduction system (bundle branch re-entry) * success rate Complications: 1) stroke during procedure (1%) [5] 2) cardiac tamponade requiring pericardiocentesis [6] - caused by perforation of the myocardium - occurs within a mean of 10 days, but may occur hours or weeks after procedure [1] - dyspnea, hypotension, elevated jugular venous pressure, narrow pulse pressure, pulsus paradoxus 3) atrioesophageal fistula - 1-4 weeks after procedure - neurologic symptoms may occur due to esophageal air embolization [1] 4) pulmonary vein stenosis - may develop months to years after procedure - dyspnea, cough, chest pain, hemoptysis 5) mortality is 1 in 1000 patients or 1 in 1385 procedures [3] Management: - see specific indication Notes: Limitations: 1) need for hemodynamic stability to allow for accurate mapping of conduction abnormalities 2) of limited use in the setting of coronary artery disease 3) residual cardiac arrhythmias in 1/2 of patients undergoing ablation for paroxysmal atrial fibrillation [6]

Specific

ablation for atrial fibrillation; pulmonary vein isolation/ablation atrioventricular (AV) nodal ablation radiofrequency atrial ablation radiofrequency ventricular ablation

General

cardiac radioablation (photodynamic cardiac ablation)

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, 18. American College of Physicians, Philadelphia 1998, 2018
  2. Journal Watch 25(3):22-23, 2005 Hsu LF, Jais P, Sanders P, Garrigue S, Hocini M, Sacher F, Takahashi Y, Rotter M, Pasquie JL, Scavee C, Bordachar P, Clementy J, Haissaguerre M. Catheter ablation for atrial fibrillation in congestive heart failure. N Engl J Med. 2004 Dec 2;351(23):2373-83. PMID: 15575053
  3. Cappato R et al Prevalence and causes of fatal outcome in catheter ablation of atrial fibrillation. J Am Coll Cardiol 2009 May 12; 53:1798. PMID: 19422987 - Belhassen B. A 1 per 1,000 mortality rate after catheter ablation of atrial fibrillation: An acceptable risk? J Am Coll Cardiol 2009 May 12; 53:1804. PMID: 19422988
  4. Terasawa T et al Systematic review: Comparative effectiveness of radiofrequency catheter ablation for atrial fibrillation. Ann Intern Med 2009 Aug 4; 151:191. PMID: 19581635
  5. Wilber DJ et al Comparison of Antiarrhythmic Drug Therapy and Radiofrequency Catheter Ablation in Patients With Paroxysmal Atrial Fibrillation. JAMA. 2010;303(4):333-340. PMID: 20103757 http://jama.ama-assn.org/cgi/content/full/303/4/333
  6. Morillo CA et al Radiofrequency Ablation vs Antiarrhythmic Drugs as First-Line Treatment of Paroxysmal Atrial Fibrillation. (RAAFT-2)A Randomized Trial JAMA. 2014;311(7):692-700. PMID: 24549549 https://jama.jamanetwork.com/article.aspx?articleid=1829990 - Calkins H Has the Time Come to Recommend Catheter Ablation of Atrial Fibrillation as First-Line Therapy? JAMA. 2014;311(7):679-680 PMID: 24549546 http://jama.jamanetwork.com/article.aspx?articleid=1829970
  7. Maan A, Shaikh AY, Mansour M, Ruskin JN, Heist EK. Complications from catheter ablation of atrial fibrillation: a systematic review. Crit Pathw Cardiol. 2011 Jun;10(2):76-83. Review. PMID: 21988947
  8. NEJM Knowledge+ Question of the Week. Jan 19, 2021 https://knowledgeplus.nejm.org/question-of-week/37/