High-energy His bundle ablation. A treatment of last resort.

A proportion of patients with atrial fibrillation and other supraventricular arrhythmias remain refractory to medical therapy and require definitive treatment. In some cases, the arrythmia may be cured by catheter or surgical ablation. Techniques have recently been developed for disruption of the substrate for atrioventricular nodal reentry tachycardia'-3 and atrial flutter,4'5 and a potential surgical cure for atrial fibrillation6 has recently been described. These techniques cure the arrhythmia while allowing preservation of atrioventricular conduction. In many cases, however, the arrhythmia cannot easily be cured; under these circumstances, the physician may consider His bundle ablation, which entails destruction of part of the