title: New developments and treatment strategies in patients with supraventricular tachyarrhythmias.
abstract: The mechanisms, clinical presentation and therapy of supraventricular tachycardias are discussed. The therapy has changed from palliation by means of anti-arrhythmic drugs into definitive cure by ablation of the arrhythmia substrate. Radiofrequency energy causes tissue damage by heating and appears to be a safe method for catheter ablation of supraventricular tachycardias. We report a 97% success rate for radiofrequency ablation of 195 accessory atrioventricular pathways thereby curing these patients from circus-movement tachycardia and paroxysmal atrial fibrillation. Complications occurred in 3% of patients. One hundred seventy-two patients with atrioventricular nodal reentrant tachycardia, caused by reentry within dual AV-nodal pathways, were treated by selectively ablating one of the pathways with non-inducibility of the arrhythmia afterwards in 97% of the cases. Nine percent of patients had a recurrence but were successfully treated in a second session. The procedure was complicated by complete AV-block in 4% of patients. The disappointing medical treatment of atrial fibrillation and the fact that atrial fibrillation can be the cause of a reversible form of heart failure (tachycardiomyopathy), induced the clinical application of alternative forms of treatment. Ablation of the normal atrioventricular conduction system by using radiofrequency energy was performed with a 100% success rate in 121 patients. After implantation of a ventricular pacemaker it is possible to control and regulate the ventricular rhythm leading to rate control and amelioration of ventricular performance.
authors.affiliation: Cardiologisch Centrum, O.l.v.-Ziekenhuis, Aalst.
authors.forename: P
authors.initials: P
authors.lastname: Geelen
authors.forename: E
authors.initials: E
authors.lastname: Andries
authors.forename: P
authors.initials: P
authors.lastname: Brugada
mesh_terms: D001281:Atrial Fibrillation / Q000628:therapy; D001282:Atrial Flutter / Q000628:therapy; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000628:therapy; D013617:Tachycardia, Supraventricular / Q000503:physiopathology / Q000628:therapy*