RADIOFREQUENCY CATHETER ABLATION OF ATRIA L ARRHYTHMIAS

Atrial arrthytmias resistant to medical therapy are still a common ind ication for ablation of the normal atrioventricular conduction pathway (Tawara node and His Bundle). However, the development of catheter te chniques of intra atrial ablation to destroy arrhythmogenic nic myocar dial zones enables radical cure of the arrhythmias with the respect of the nodo-hisian pathway. With respect to common flutter, a number of series, including our own, show a 50 to 75 % long-term success rate. W e believe that a very high success rate in the ablation of flutter wil l probably be achieved in a reproducible manner but this will require a more accurate understanding of the tachycardia circuit and technolog ical developments allowing controlled radio-frequency destruction of b igger atrial myocardial zone. Experience of radio-frequency ablation a trial of atrial extrasystoles is more limited than that of flutter and there are fewer published series. Globally, catheter ablation of atri al tachycardia remains a more difficult and a less well codified proce dure than that of accessory pathways or of intra-nodal reentry. Radio- frequency ablation in this indication is not without danger in view of the thinness of the atrial wall. We believe that radio-frequency cath eter ablation for atrial arrthythmias should, for the moment, be reser ved for centres specialised in the techniques of electrophysiological investigation and ablation.