Transvenous Radiofrequency Catheter Ablation for Atrial Flutter and Atrial Fibrillation

Abstract

Now this is not the end. It is not even the beginning of the end, but it is, perhaps the end of the beginning. —Winston Churchill, November 10, 1942 Transvenous radiofrequency catheter ablation (RFA) for treatment of atrioventricular (AV) reentrant tachycardia and AV nodal reentrant tachycardia is remarkably successful. To the best of my knowledge, there has not been a large randomized trial comparing RFA with other treatments for these tachycardias. The lack of such trials is due at least in part to the self-evident efficacy of RFA in this setting. In turn, the efficacy of RFA for these tachycardias is in large part due to the fact that the anatomy and pathophysiology of these two tachycardias are well understood. The success of RFA for treating AV reentrant tachycardia and AV nodal reentrant tachycardia has quite rightly led to a large effort to expand this success, and thereby the indications for RFA, to other tachyarrhythmias. Article p 1676 Among the supraventricular tachyarrhythmias, the atrial flutter (AFL)/atrial fibrillation (AF) family is an obvious but challenging target for RFA. The early results are promising. AF is numerically the largest member of this family of tachyarrhythmias. The other family members are atrial tachycardia and AFL. These tachyarrhythmias can be closely related anatomically, can share a common pathophysiology, and can be found in the same patient.1 There are probably several different anatomies and pathophysiologies for these tachyarrhythmias. Inability to fully understand the anatomy and pathophysiology of a tachyarrhythmia in an individual patient makes RFA more difficult and to some extent empiric. Among the various AFLs, one is well understood. So-called classic, typical, common, or isthmus AFL has a characteristic but not unique surface ECG pattern: a “saw-tooth” pattern of p waves in the inferior leads (II, III, and aVF). It is a reentrant …