Chapter 13: Catheter Ablation

One of the major advances in the management of cardiac arrhythmias during the past 25 years has been the innovation of catheter ablation. Initially performed in the early 1980s, this technique may be attributed to the pioneering work of Dr. Melvin Scheinman.

The first technique in which catheter ablation was performed invoked the application of direct current energy from the end of a pacing catheter and attached to a skin electrode/plate to destroy focal cardiac tissue. Dr. Scheinman described a series of patients with drug-refractory supraventricular tachycardias in which a pacing catheter was placed near the His bundle (AV junction). Electrical energy was applied and resulted in complete heart block, which served to control the tachyarrhythmias. This technique is of limited clinical use, though, since the patient becomes pacemaker dependent. Refinement of this technique has occurred over many years.

Eventually a more focal energy delivery system with radiofrequency energy was employed and described by Dr. Steven Huang. Attaching a radiofrequency generator at wavelengths of 300-500 megahertz (MHz) enables electrical energy to be delivered to large-tip, steerable electrophysiology catheters that are placed percutaneously. This technique creates focal myocardial lesions that are well circumscribed. The size of the electrode and the amount of energy delivered to that electrode determine the size of the myocardial lesion produced through resistive heating. Cooling the tip of the electrode can create larger lesions.

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