NEW HORIZONS IN CATHETER ABLATION

Catheter ablation has evolved into the dominant therapeutic modality i n the treatment of a variety of arrhythmias, particularly supraventric ular arrhythmias with the mechanisms of atrioventricular (AV) nodal re entry and AV reciprocating tachycardia via an accessory pathway. The m ode of catheter ablation used in the great majority of cases is radiof requency (RF) catheter ablation. This technology is well-suited for th e above arrhythmias because the targets and the RF lesions are both sm all and discrete. Using temperature monitoring may improve the outcome of these procedures by decreasing procedure time and incidence of coa gulum formation on the catheter after a sudden rise in electrical impe dance. 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 cur rently underway to create a catheter based ''maze'' procedure for the treatment of atrial fibrillation. As techniques and technologies evolv e, a greater proportion of patients with symptomatic or threatening ar rhythmias may be approached with catheter ablation as a curative or pa lliative procedure.