What is primary RF ablation for ventricular tachycardia ?
Posted Aug 31 2009 10:33pm
Ventricular tachycardias , especially incessant ones not controlled by drugs are very troublesome . Radio frequency ablation is the treatment of choice currently. Principles of electrophysiology would demand acccurate localisation of the tachycardia focus and then ablate it with RF energy .This requires induction of the clinical arrhythmia on the EP table, mapping , identifying the circuits and ablate the optimal points of reentry or slow conduction or P potentials
In reality , some times ( or Is it many times ! ) , tentative ablation
in the ” V-tach Zone” without mapping is more easier and surprisingly more effective than the much scientific approach of localising the circuit and inducing the arrhythmia.This is referred to as primary ablation
Is it not a crude method to blindly burn cardiac tissues ?
No, we are not worried by the crudeness , as long as it is safe and effective. Experience have made us clever, inducing a VT in the EP lab can be very demanding to our senses and it is a true stress test for the cardiologist’s patience and endurance.Primary ablation has reduced fluroscopic time, procedural time and most unexpectedly increased the success rate!
So even a relatively unscientific blind burn may be better than a scientific burn ?
Yes. It seems to be , at least in idiopathic VTs of fasicular origin and some VTs in RVOT.
Heart is a 400gram organ , it can afford to lose few grams of tissue , especially when it is pathological and behave aberrantly