ABLATIVE TECHNIQUES AS AN ALTERNATIVE TO DRUG-TREATMENT OF JUNCTIONALTACHYCARDIAS

The clinical syndrome corresponding to junctional tachycardia is gener ally known as Bouveret's disease, but actually corresponds to two quit e separate entities: 1) tachycardia related to a secondary atrioventri cular pathway or Kent bundle; 2) intranodal tachycardia arising in the atrio-ventricular node. Until recently, antiarrhythmics were used to treat most of the cases of accessory pathways. If this was unsuccessfu l or if the anti-arrhythmics induced adverse effects and in life-threa tening cases affecting Kent bundles, surgical section was sometimes pr oposed, carrying a non-negligible risk of morbidity and mortality. Int ranodal arrhythmia is not a serious, but may call for prophylactic ant iarrhythmic treatment if it becomes too frequent and disabling. Before the advent of ablative treatment, there was no satisfactory alternati ve to antiarrhythmic treatment. Ablation of the accessory pathways or selection ablation of the slow pathway of the atrio-ventricular node ( sometimes of the rapid pathway) is not achieved by applying a high-fre quency current (radiofrequency), which has virtually replaced fulgurat ion (destruction using a modified electrical current). In both types o f tachycardia, a cure is obtained in 90 % of cases with a low incidenc e of complications and virtually no risk of mortality, which contrasts favorably with long-term antiarrhythmic treatment (or surgical sectio n of Kent bundles), which justifies the large-scale development of rad iofrequency ablation.