Catheter ablation has revolutionized the management of tachyarrhythmias, offering a potential cure rather than lifelong drug therapy. Modern procedures use radiofrequency energy (or increasingly, cryoablation ❄️) instead of the older direct current (DC) shocks. The principle: deliver targeted thermal energy to create a small scar in arrhythmogenic tissue → interrupts the abnormal electrical pathway.
⚡ Arrhythmias Treated
- 🔁 Atrioventricular Reentrant Tachycardia (AVRT) – e.g. Wolff–Parkinson–White syndrome.
- 🔄 Atrioventricular Nodal Reentrant Tachycardia (AVNRT) – the commonest SVT cured with ablation.
- 🎯 Atrial Tachycardia – focal or macro-reentrant forms.
- 🌀 Atrial Flutter – very high success rates with ablation of the cavotricuspid isthmus.
- ❤️ Atrial Fibrillation – pulmonary vein isolation is now a major strategy in AF management.
- 💥 Idiopathic Ventricular Tachycardia and Bundle Branch Reentrant VT – ablation is often curative in selected patients.
⚠️ Complications
- 📉 AV block – may require permanent pacemaker insertion.
- 🛑 Emergency cardiac surgery – rare but possible if structural damage occurs.
- 🧠 Thromboembolism – stroke, systemic embolism, or pulmonary embolism.
- 💀 Procedure-related death – extremely rare but must be consented for.
- 🕳️ Atrial–esophageal fistula – rare, devastating complication of left atrial ablation.
- 💧 Pericardial tamponade – due to perforation from ablation catheter.
📚 Teaching Pearl
Catheter ablation is now first-line therapy for many SVTs (e.g. AVNRT, AVRT) because of high cure rates (>95%) and low recurrence.
In AF, it is usually reserved for symptomatic patients who fail antiarrhythmic drugs, but is increasingly moving up guidelines.
Always balance benefits (potential cure, drug-free life) against risks (tamponade, AV block, stroke).
