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Radiofrequency ablation
Last reviewed: 04.07.2025
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If the development of tachyarrhythmia is due to the presence of a specific conduction pathway or an ectopic rhythm source, this zone can be ablated by a low-voltage, high-frequency (300-750 MHz) electrical impulse delivered by an electrode catheter. This energy damages and necrotizes an area < 1 cm in diameter and approximately 1 cm deep. Before the moment of application of the electrical discharge, the corresponding zones must be identified by electrophysiological examination.
The response rate is >90% in re-entry tachycardias (at the AV junction or accessory pathways), focal atrial tachycardia and flutter, and focal idiopathic VT (re-entry VT in the RV outflow tract, left IVS, or bundle branches). Because atrial fibrillation often originates or is sustained at the level of the arrhythmogenic zone at the pulmonary veins, this zone can be directly ablated or, less commonly, electrically isolated by ablation of the pulmonary vein entry into the left atrium or at the level of the left atrium. Alternatively, in patients with AF and a high ventricular rate, AV node ablation with permanent pacemaker implantation can be performed. Radiofrequency ablation is sometimes effective in drug-refractory VT and coronary artery disease.
Radiofrequency ablation is safe. Mortality is less than 1:2000. Complications include valve injury, embolism, cardiac perforation, tamponade (1%), and accidental AV node ablation.
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