Learning by burning in atrial fibrillation: an uncertain, complicated quest.

摘要

Catheter ablation of cardiac arrhythmias has been a fantastic success in modern Cardiology because it came to fill the remaining gap from hypothesis to proof of concept. During the 1970s and 1980s studies with intracardiac recordings and programmed stimulation led to a better understanding of arrhythmia mechanisms that allowed the surgeons to start a new era in the treatment of arrhythmias. Then, catheter ablation went a step further as it allowed testing the mechanistic hypothesis by creating very localized lesions. Perhaps the best example of this is accessory pathway ablation. Disappearance of delta waves or interruption of atrioventricular (AV) tachycardia within seconds of radiofrequency (RF) application provided proof of the accurate localization of the pathway and of the mechanism of tachycardia.1-2 The history of reentrant nodal tachycardia is a little different because the anatomic targets were not so precisely defined, but still, the abolition of conduction through one of the nodal pathways was predictive of success and again supported the dual-AV nodal pathways mechanistic hypothesis.