Catheter ablation techniques in patients with supraventricular tachycardia.

Catheter ablation is an experimental procedure that may prove useful for patients with drug-refractory supraventricular tachycardia. Current techniques involve the use of high-energy direct-current shocks, delivered via electrode catheters. These techniques have been used most commonly for ablating the atrioventricular (AV) junction in patients with supraventricular tachycardia. Such ablation may be of value in a subset of patients with the Wolff-Parkinson-White syndrome. In addition, limited data suggest that direct catheter ablation of posteroseptal accessory pathways may prove safe and effective when shocks are applied just outside the os of the coronary sinus. Catheter ablation has also been used in small numbers of patients with ectopic atrial tachycardia. The chief limitation of catheter ablation of the AV junction is the induction of pacemaker dependency. Successful ablation of an accessory pathway or of an ectopic atrial tachycardia focus obviates the need for long-term pacing. For many reasons, catheter ablation represents an exciting approach to the management of patients with drug-refractory supraventricular tachycardia.