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[Percutaneous ablation therapy of atrial fibrillation: good expectations].

Rev Esp Cardiol 2003;56(4):331-2 331 Today the majority of tachyarrhythmias can be treated with percutaneous ablation.1 To summarize, the ablation procedure consists of transmitting energy (generally radiofrequency) to the distal electrode of a catheter introduced into the heart via a vein or artery. This electrode, once placed at the site chosen by means of electroanatomic references, selectively destroys the substrate of each tachycardia, whether they are abnormal electrical connections, ectopic foci, or isthmus of myocardial tissue. In this manner, percutaneous ablation has become the treatment of choice for curing the majority of patients with Wolf-Parkinson-White syndrome, re-entrant tachycardias via nodal re-entry, atrial tachycardias, atrial flutter, and some ventricular tachycardias. Nevertheless, in 2 types of arrhythmia it seems to be difficult to establish ablation via catheter as a therapeutic option: these arrhythmias are ventricular fibrillation and atrial fibrillation. With respect to ventricular fibrillation, this has very recently been treated with ablation in a reduced number of patients but, on a day-to-day basis, the most efficacious and safe treatment for the majority of individuals with the risk of suffering this arrhythmia continues to be the implantable defibrillator.2 With respect to atrial fibrillation, treatment has been and continues to be basically pharmacological, but ablation may be used in the near future, at least in certain patients. This is due to the fact that recent investigations have shown that atrial fibrillation may have a focal origin, and that if this focus remains active for a long enough period of time it can change the electrical properties of the atrial myocardium in such a way that the atrial fibrillation may continue to exist despite the disappearance of the focus.3-5 This phenomenon is called atrial ED I TO R I A L S