NASPE 25TH ANNIVERSARY SERIES Catheter Ablation of Supraventricular Arrhythmias: State of the Art

The era of catheter ablation for the treatment of arrhythmias began in 1981, when Dr. Melvin Scheinman performed the first atrioventricular junction ablation using direct-current shocks in a patient with drug-refractory atrial fibrillation and an uncontrolled ventricular rate.1 Because of the barotrauma associated with intracardiac high-energy shocks, direct-current catheter ablation played only a limited role in the treatment of arrhythmias. With the advent of radiofrequency catheter ablation in the late 1980s, the range of arrhythmias amenable to catheter ablation and the number of patients who could be treated safely by catheter ablation vastly expanded. In the past decade, radiofrequency catheter ablation has become firmly established as first-line therapy for paroxysmal supraventricular tachycardia and typical atrial flutter. Furthermore, although still in an evolutionary phase, catheter ablation to eliminate atrial fibrillation has been demonstrated in the past 5 years to be feasible and clinically useful. The intent of this article is to review the current status of catheter ablation for the treatment of paroxysmal supraventricular tachycardia, atrial flutter, and atrial fibrillation.