[Electrotherapy of supraventricular tachycardia (atrial fibrillation/atrial flutter)].

Abstract

Contrary to patients with the WPW-syndrome and AV nodal reentry in whom radiofrequency catheter ablation is the therapy of first choice for cure from these arrhythmias instead of life-long medical therapy, pharmacologic therapy of atrial fibrillation and atrial flutter remains the treatment of choice in these patients. If, however, atrial fibrillation with rapid atrioventricular conduction is medically intractable and associated with severe haemodynamic impairment, these patients may be offered catheter ablation of AV conduction by radiofrequency energy. Compared to DC ablation, this approach is associated by an acceptable complication rate. Including the left ventricular approach in cases where it is not possible to ablate AV conduction using the venous approach, the success rate to achieve third degree AV block approaches 100%. With the development of temperature-controlled radiofrequency catheter ablation, a further reduction of side effects is anticipated. A disadvantage of this approach is the need for permanent pacemaker implantation (usually rate-adaptive VVI stimulation) after induction of complete AV block. Therefore, the advantage of normalization of ventricular rate by ablation of AV conduction has to be weighed against the risk of life-long pacemaker treatment for complete AV block in every patient. Patients with medically intractable typical atrial flutter may be offered the following alternative modes of electric treatment: selective ablation of the area of slow conduction sustaining circus movement in the right atrium underlying atrial flutter, by radiofrequency energy without interrupting AV conduction, implantation of a permanent antitachycardia pacemaker with electrodes positioned in the right atrium, radiofrequency catheter ablation of AV conduction.(ABSTRACT TRUNCATED AT 250 WORDS)