Clinical review of radiofrequency catheter ablation for cardiac arrhythmias.

Clinical tachycardias are a major cause of morbidity with detrimental effects on quality of life, physical activity and health care costs. Catheter ablation delivered by radiofrequency energy (RFA) has gradually expanded as a therapeutic modality for cure or palliation and is being adapted to address the most difficult to treat tachycardias. The purpose of this paper is to inform decision makers about the current evidence base of RFA through a comprehensive literature review. Of the 968 citations identified through the literature search strategy, 111 studies (11%) met the inclusion criteria. Only 10 of these studies (9%) were randomized, controlled trials. RFA of paroxysmal supraventricular tachycardia, atrial flutter and focal atrial tachycardias are all procedures associated with high procedural success rates and sustained clinical improvement within two years of follow-up. Limited evidence also demonstrates that elimination of these tachycardias improves symptoms and quality of life. RFAs of atrial fibrillation and ventricular tachycardia secondary to underlying structural heart disease are currently considered experimental procedures because there remains insufficient published data to draw conclusions about their clinical efficacy and safety profile. For all of the ablation procedures, there is a paucity of high-quality outcome studies comparing ablation with alternative therapeutic approaches and this provides the opportunity for future research.