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Biomedical subjects

S Osswald

Publications and source records attributed to S Osswald.

At least 37 records · Page 2Linked to original sources
PubMed1998

Time dependence of left ventricular recovery after delayed recanalization of an occluded infarct-related coronary artery: findings of a pilot study.

OBJECTIVES: We sought to test the hypothesis that late recanalization of infarct-related coronary arteries (IRAs) improves long-term left ventricular (LV) function. BACKGROUND: Reperfusion within 24 h of an acute myocardial infarction (MI) has been shown to improve myocardial healing and to reduce infarct expansion. Uncontrolled data suggest that there may be a time window of several weeks for such an effect. METHODS: Sixteen asymptomatic patients 10 +/- 4 days after a first Q wave anterior wall MI with persistent left anterior descending coronary artery occlusion and infarct-zone akinesia were randomized to immediate (2 weeks) or delayed (3 months) angioplasty. Repeat catheterization and cardiac magnetic resonance imaging (MRI) were performed after 3 and 12 months. RESULTS: Angiography 3 months after MI revealed that LV ejection fraction (LVEF) had increased ([mean +/- SD] 54.4 +/- 4.3% vs. 63.9 +/- 7.4%, p < 0.01) as a result of improved regional function (p < 0.01) and LV end-systolic volume had decreased (p < 0.002), whereas LV end-diastolic volume remained unchanged. With delayed angioplasty, LVEF, infarct zone wall motion and LV volumes did not improve. Cardiac MRI at baseline and at 3 and 12 months confirmed these findings and extended them up to 1 year, indicating that delayed angioplasty could no longer improve LV function because of marked LV dilation (p < 0.01). Immediate angioplasty had a high success rate, but restenosis (50%) was accompanied by new severe angina as a clinical indicator of salvaged myocardium, which did not occur after delayed angioplasty. CONCLUSIONS: This pilot study in selected patients supports the hypothesis that myocardial viability persists ("hibernation") for 2 to 3 weeks but not for 3 months after MI, during which time it may be worthwhile to restore blood flow to a large myocardial territory, even in asymptomatic patients, to improve long-term LV function.

Adult↗
PubMed1998

Selective versus non-selective antiarrhythmic approach for prevention of atrial fibrillation after coronary surgery: is there a need for pre-operative risk stratification? A prospective placebo-controlled study using low-dose sotalol.

AIM: This study evaluated the advantages of 'selective' over 'non-selective' antiarrhythmic prevention of atrial fibrillation after coronary surgery based on a new risk prediction algorithm. METHODS AND RESULTS: In a retrospective analysis of a prospective randomized trial, a model for risk prediction was determined based on clinical data of the control group (A; n = 107) and tested in a test group (B; n = 107, treated with low dose sotalol). Using this algorithm, the effect of a 'selective' antiarrhythmic approach in high-risk patients was compared to a 'non-selective' approach, where all patients were treated. In total, 75 (35%) patients developed atrial fibrillation and 14 (7%) side-effects led to discontinuation of study medication. Based on the risk prediction algorithm, 36% of group A patients were classified as high-risk patients with an incidence of atrial fibrillation of 76% compared to 26% in low-risk patients (P < 0.0001). The selective approach, i.e. treatment of high-risk patients only reduced the incidence of atrial fibrillation from 76% to 50% (P = 0.0295) compared to a reduction from 44% to 26% (P = 0.0065) when all patients were treated. More importantly, with the non-selective approach 100% of patients were exposed to the possible side-effects of sotalol and costs compared to 24% only with the selective approach (P < 0.0001). CONCLUSIONS: Thus, a selective approach based on a clinical risk prediction algorithm should improve the cost-effectiveness and safety of low-dose sotalol in the prevention of atrial fibrillation after coronary bypass surgery.

Adult↗
PubMed1998

Transvenous single lead atrial defibrillation: efficacy and risk of ventricular fibrillation in an ischemic canine model.

Transvenous atrial defibrillation with multiple atrial lead systems has been shown to be effective in models without the potential for ventricular arrhythmias. The specific aim of this study was to evaluate the efficacy and safety of transvenous single lead atrial defibrillation in a canine model of ischemic cardiomyopathy. Ten dogs had ischemic cardiomyopathy induced by repeated intracoronary microsphere injections. The mean LV ejection fraction decreased from 71% +/- 9% to 38% +/- 14% (P = 0.003). Spontaneous atrial fibrillation (AF) developed in four dogs, and in six AF was induced electrically. Atrial defibrillation thresholds (ADFTs) were determined with synchronous low energy shocks using a transvenous tripolar lead with two defibrillation coils (right ventricle, superior vena cava) and an integrated sensing lead (RV coil vs electrode tip). The ADFTs derived by logistic regression were compared at 50% and 90% probability of success (ED50, ED90): ED50 was 2.4 +/- 1.7 J and 2.9 +/- 2.1 J, respectively, for 5- and 10-ms monophasic shocks, and 1.8 +/- 0.9 J, respectively, for 5- and 10-ms biphasic shocks. Immediately after 3 of 2,179 (0.1%) synchronized shocks, ventricular fibrillation (VF) developed. VF was induced in 3 of 1,062 (0.3%) shocks with integrated sensing (RV coil vs electrode tip) compared to 0 of 1,117 shocks when a separate bipolar RV sensing electrode was used for synchronization. In our canine model of ischemic cardiomyopathy, low energy atrial defibrillation via a transvenous single lead system was highly effective. However, there was a small but definite risk of VF induction, which seemed to be greater when an integrated as opposed to a true bipolar RV sensing was used.

Animals↗
PubMed1998

New ICD-technologies: first clinical experience with dual-chamber sensing for differentiation of supraventricular tachyarrhythmias.

Inappropriate ICD therapy for supraventricular arrhythmias remains an unsolved problem and may lead to serious clinical situations. Current algorithms for differentiation of supraventricular and ventricular arrhythmias are based on ventricular sensing solely and, therefore, lack sensitivity and specificity. This preliminary analysis from a multicenter trial comprises data from the first 26 patients who received a Res-Q Micron active-can ICD (Sulzer Intermedics) with a ventricular defibrillation lead and an additional bipolar lead for atrial sensing. Digitized atrial and ventricular waveform storage as well as interval charts from 102 induced and 30 spontaneous arrhythmia episodes were prospectively collected and analyzed with regard to appropriateness of ICD therapy. From all 132 arrhythmia episodes, high-quality stored dual-chamber intracardiac electrograms (IEGM) could be retrieved for further analysis: in 40 (30%) episodes, atrial fibrillation (AF with rapid ventricular response 22, AF with VT 9, AF with VF 9) was identified as the underlying intrinsic rhythm, and inappropriate ICD therapy was delivered in 4/22 (18%) episodes of AF with rapid ventricular response. In the remaining 92 (70%) episodes, sinus rhythm was the underlying atrial rhythm (SR with VT 13, SR with VF 79), and no inappropriate therapy was observed. Three of 22 (15%) high-energy shocks delivered for ventricular arrhythmias (VT 9, VF 9, rapid AF 4) terminated AF at the same time. In total, there were 3 complications (2 atrial lead dislodgments, 1 revision for bleeding). Both atrial lead dislodgments occurred in the 2 patients with passive-fixation leads compared to none in the 24 patients with active-fixation leads (p = 0.003). In conclusion, dual-chamber sensing and waveform storage of the new Res-Q Micron offer very helpful diagnostic tools for the detection of inappropriate ICD-therapy. Placement of an additional atrial lead is safe and does not interfere with proper ICD function. However, for avoidance of atrial lead dislodgment, active fixation leads are recommended. With the tested active-can lead configuration, the efficacy of successful atrial cardioversion by high-energy shocks delivered for ventricular arrhythmias seems to be low.

Algorithms↗
PubMed1998

Predictors of loss of atrioventricular synchrony in single lead VDD pacing.

OBJECTIVE: To evaluate maintenance of proper VDD function, defined as persistence of sinus rhythm with atrial synchronous ventricular pacing, and to define factors predicting failure of the VDD mode in patients with atrioventricular (AV) block and normal sinus function. DESIGN: Observational study in 86 consecutive patients (mean (SD) age 74 (12) years; 38 women, 48 men) with single lead VDD pacing systems (Intermedics Unity, n = 66, Medtronic Thera VDD, n = 20), implanted for high degree AV block with documented normal sinus node. Pacemaker function was assessed by event counters, telemetric measurements, and Holter recordings. Demographic, radiological, and pacing variables were correlated with loss of proper VDD function. RESULTS: During a mean (SD) follow up of 10 (10) months (range 1-37), sinus rhythm and atrial triggered ventricular pacing were maintained in 70 of 86 patients (81%). Atrial undersensing was observed in nine patients, lead migration in two, atrial fibrillation in three, and symptomatic sinus bradycardia in two. Univariate predictors of loss of proper VDD function were: low position of the atrial dipole relative to the carina (> or = 6 cm; p < 0.01) during fluoroscopy; and maximum programmable atrial sensitivity of the pacemaker (p = 0.03). In a multivariate analysis, only dipole position remained predictive of outcome (p < 0.02). Not predictive were sex, age, symptoms before pacemaker implantation, cardiothoracic ratio or dilatation of individual heart chambers on chest x ray, side of device implant, and P wave amplitude at implant. CONCLUSIONS: To maintain proper VDD function in the long term, a low anatomical dipole position relative to the carina should be avoided. Electrical guidance of dipole positioning does not seem to influence long term outcome.

Adolescent↗
PubMed1998

Significance of Supraventricular Tachyarrhythmias After Coronary Artery Bypass Graft Surgery and Their Prevention by Low-Dose Sotalol: A Prospective Double-Blind Randomized Placebo-Controlled Study.

BACKGROUND: The single most frequent complication after coronary artery bypass graft surgery is the occurrence of supraventricular tachyarrhythmias leading to a prolonged hospital stay. Although several drugs have been used to treat these arrhythmias, effective prevention was only possible with beta-blocking drugs in selected patients. It was, therefore, the aim of the present study to evaluate the significance of supraventricular tachyarrhythmias in presence of today's cardioprotective management in a broad spectrum of patients and to assess the possible preventive effect and safety of low-dose sotalol after coronary artery bypass graft surgery. METHODS AND RESULTS: In a prospective randomized double-blind placebo-controlled trial, 220 consecutive patients referred for elective coronary artery bypass graft surgery were randomized to 80 mg sotalol twice daily (n = 110) or matching placebo (n = 110) for 3 months with the first dose given 2 hours before surgery. There were no significant differences in baseline characteristics between the two groups. Low-dose sotalol reduced the rate of supraventricular arrhythmias from 43% (placebo) to 25% (sotalol, P <.01), which was atrial fibrillation in 83%, flutter in 7%, and other supraventricular arrhythmias in 10%. Only 7% of all arrhythmias were observed after day 9. Hospital stay was 11 +/- 4 days in patients with supraventricular arrhythmias versus 9 +/- 2 days (P <.001) in patients without. On the fourth postoperative day, heart rate was lower in the sotalol group (75 +/- 12 versus 86 +/- 14 beats per min; P <.0001), but QTc was not significantly prolonged (sotalol, 0.44 +/- 0.03; placebo, 0.43 +/- 0.03; P, ns). Study medication had to be discontinued due to side effects in 6.4% of sotalol and 3.6% of placebo patients (P, ns), but relevant side effects occurred only in two sotalol patients late after surgery. CONCLUSIONS: These data show that without antiarrhythmic therapy the incidence of supraventricular arrhythmias after coronary artery bypass graft surgery is high (43%) and that supraventricular arrhythmias were associated with a prolonged hospital stay (+/-2 days). Prophylactic treatment with low-dose sotalol reduced the incidence of supraventricular arrhythmias significantly (by 40%), thereby reducing overall hospital stay in treated patients. Because more than 90% of all supraventricular arrhythmic episodes occurred within 10 days after surgery and considering the small proarrhythmic effect of sotalol late after surgery, prophylactic treatment with sotalol may be recommended for the first 10 postoperative days to safely reduce supraventricular tachyarrhythmias.

Journal Article↗
PubMed1997

[Survived sudden cardiac death in aortic stenosis and Wolff-Parkinson-White syndrome: Differential diagnosis and therapy].

Based on a case of a 72 year old woman with hemodynamically non-significant aortic stenosis. WPW-syndrome and out-of-hospital cardiac arrest, the diagnostic assessment and differential diagnosis of potentially fatal arrhythmias are discussed. In particular, the incidence of supraventricular and ventricular arrhythmias in patients with WPW-syndrome, their prognostic impact and therapeutic options are outlined.

Aged↗
PubMed1997

[Radiofrequency ablation of supraventricular tachycardia].

Most forms of supraventricular tachycardia are based on a reentry-mechanism which is maintained by a specific anatomic substrate (e.g., dual AV-nodal physiology, accessory pathway). Since this substrate is usually a very localized and well defined anatomical abnormality, focal thermocoagulation by radiofrequency energy is highly effective in restoring normal physiology, thereby offering definite cure to a high percentage of these patients. The present article summarizes pathophysiologic mechanisms as well as diagnostic electrophysiologic testing- and ablation-techniques. Clinical success and complications are discussed in the light of current indications for elective radiofrequency ablation of supraventricular tachycardias.

Atrial Fibrillation↗
PubMed1997

Prevention of supraventricular tachyarrhythmias after open heart operation by low-dose sotalol: a prospective, double-blind, randomized, placebo-controlled study.

BACKGROUND: The aim of this prospective, double-blind, placebo-controlled trial was to assess the preventive effect and safety of low-dose sotalol after heart operation. METHODS: Two hundred fifty-five consecutive patients referred for elective coronary artery bypass grafting (n = 220) or aortic valve operation (n = 35) were randomized to receive either 80 mg of sotalol twice daily (n = 126) or matching placebo (n = 129) for 3 months, with the first dose given 2 hours before operation. RESULTS: There were no significant baseline differences between the groups. Overall, supraventricular tachyarrhythmias occurred in 36% of patients (82% atrial fibrillation). Hospital stay was 11.6 +/- 5 days in patients with supraventricular arrhythmias, versus 9.5 +/- 2.4 days in patients without it (p < 0.0001). Low-dose sotalol reduced the rate of supraventricular arrhythmias from 46% (placebo) to 26% (sotalol; p = 0.0012), or by 43%. On the fourth postoperative day, heart rate was lower in the sotalol group (74 +/- 12 beats/min versus 85 +/- 15 beats/min; p < 0.0001) but the QT interval corrected for the heart rate was not prolonged (sotalol group, 0.44 +/- 0.03 second; placebo group, 0.43 +/- 0.03 second; p = not significant). Study medication had to be discontinued because of side effects in 5.6% of sotalol and 3.9% of placebo patients (p = not significant), with one possible proarrhythmic event occurring in a patient receiving sotalol. CONCLUSIONS: Because more than 90% of supraventricular arrhythmic episodes occurred within 9 days after operation and 70% of all possibly sotalol related side effects occurred after day 9, the findings in this study imply that prophylactic treatment with sotalol may be limited to the first 9 postoperative days.

Aged↗
PubMed1997

The treatment of patients with infected implantable cardioverter-defibrillator systems.

OBJECTIVE: The purpose of this study was to evaluate the treatment of patients with infected implantable cardioverter-defibrillator systems. METHODS: Retrospective analysis was done of the cases of 21 patients treated for implantable cardioverter-defibrillator infection during an 11-year period. RESULTS: Of 723 cardioverter-defibrillator implantations (550 primary implants, 173 replacements), nine (1.2%) were complicated by early postoperative device-related infections. Late infections developed in two patients 19 and 22 months, respectively, after implantation. Ten other patients were transferred to our institution for treatment of cardioverter-defibrillator infection. The time from implantation to overt infection was 2.2 +/- 1.3 months, excluding the two late infections. The responsible organisms were Staphylococcus aureus (9), Staphylococcus epidermidis (6), Streptococcus hemolyticus (1), gram-negative bacteria (3), Candida albicans (1), and Corynebacterium (1). All patients were treated with intravenous antibiotic drugs. Total system removal was done in 15 patients and partial removal in 2; in 4, the cardioverter-defibrillator system was not explanted. There were no perioperative deaths. A new implantable cardioverter-defibrillator system was reimplanted in 7 patients after 2 to 6 weeks of antibiotic therapy. Ten patients were treated without reimplantation (2 arrhythmia operation, 8 antiarrhythmic drugs). Four patients (3 patients without explantation and 1 with partial system removal) were treated with maintenance long-term antibiotic therapy. During a mean follow-up of 21 +/- 2.8 months, no patient had clinical recurrence of infection. One patient treated with antiarrhythmic drugs without system reimplantation died suddenly. CONCLUSIONS: Infections that involve implantable cardioverter-defibrillator systems can be safely managed by removing the entire system with reimplantation after intravenous antibiotic therapy. In selected patients in whom the risk for system explantation is high and anticipated life expectancy is short, long-term antibiotic therapy to suppress low-virulence infections may represent an acceptable alternative.

Adult↗
PubMed1997

Mechanisms underlying different surface ECG morphologies of recurrent monomorphic ventricular tachycardia and their modification by procainamide.

INTRODUCTION: Distinct surface ECG morphologies (ECGMs), from one episode to the next, of recurrent monomorphic ventricular tachycardia (VT) in the same patient complicate endocardial catheter mapping and the success of ablative therapy. This study investigates the incidence and mechanisms of multiple ECGMs during recurrent monomorphic VTs in a canine model of experimental myocardial infarction (MI). METHODS AND RESULTS: Computerized ECG analysis and simultaneous endocardial and epicardial activation mapping with a 64 bipolar electrode array were used to analyze the relation between site of VT origin, local activation sequence, and surface ECGM in 72 VT episodes induced in 9 of 17 dogs with experimental MI. Pairwise comparisons of all VTs induced in the same animal were done in drug-free state (47 VTs) and after intravenous procainamide (25 VTs). In drug-free state, VT pairs with similar surface ECGMs manifested endocardial breakthrough sites (BSs) within a distance < 10 mm in 46 (100%) of 46 VT pairs compared to 43 (45%) of 95 VT pairs with different surface ECGMs (P < 0.0001). Of all 89 VT pairs with endocardial BSs within < 10 mm, similar endocardial activation patterns were found in 34 (74%) of 46 pairs with similar ECGMs in contrast to 6 (14%) of 43 pairs with different ECGMs (P < 0.001). Similar comparisons of VT pairs induced after intravenous procainamide administration showed that the endocardial BSs were located within < 10 mm in 9 (75%) of 12 VT pairs with similar and in 17 (49%) of 95 with different surface ECGMs, respectively (P = NS). CONCLUSIONS: In the same heart, similar surface ECGMs of recurrent VT are highly predictive of closely spaced endocardial BSs in drug-free state, but not after procainamide administration. Nearly half of the VTs with different surface ECGMs still originate from closely spaced endocardial BSs but commonly manifest a change in the endocardial activation spread from this site. Thus, assumptions about different mechanisms and sites of VT origin based on different surface ECGMs should be made with caution.

Animals↗
PubMed1997

[Sudden loss of consciousness: clinical presentation and pathophysiologic mechanisms].

Most cases of sudden and temporary loss of consciousness [syncope] are caused by hypoperfusion of the formatio reticularis. more rarely by primary neurologic or metabolic disorders. The most common etiology is vasodepressor (vasovagal) syncope, which is caused by peripheral vasodilation due to acute withdrawal of the efferent sympathetic tone, while the parasympathetic outpour is increased at the same time. Although the efferent limb of the baroreflex manifests in a rather uniform way, the afferent parasympathetic limb is very variable, leading to a variety of clinical presentations and triggers (orthostatic hypotension, pain, fear, cough, micturition, emotions). While vasodepressor syncope mainly occurs in young people with healthy hearts, cardiac syncope caused by arrhythmias or obstructive lesions are more frequently found in elderly patients with organic heart disease. Neurogenic syncope comprises either primary neurologic disorders, such as epilepsia, or hypoperfusion of the vertebrobasilar system (TIA). Rarely, an acute increase of intracerebral pressure may cause syncope. Similarly, metabolic disorders or side effects of drugs are rare causes of syncope; however, drugs may act as important cofactors in the pathogenesis of syncope.

Arousal↗
PubMed1996

[Interventional treatment methods in atrial fibrillation].

Currently, interventional treatment modalities for atrial fibrillation chiefly comprise experimental techniques. Among the rate-control procedures, AV-nodal ablation in conjunction with permanent pacemaker implantation and transcatheter radiofrequency modulation of the AV-node are clinically accepted techniques. In contrast, the original corridor operation--which electrically isolates the left and right atrium from the sinus- and AV-node--has been changed over time and ultimately led to the development of the MAZE procedure. Among the procedures for maintenance of sinus rhythm, permanent atrial pacing and bi-atrial pacing may offer an effective--though still experimental--treatment modality in selected patients with vagally mediated or bradycardia-induced atrial fibrillation. Despite the fact that the MAZE procedure is highly effective in restoring sinus rhythm and associated with a reasonably low surgical mortality, the morbidity and complication rate of this procedure are high. Automated transvenous low-energy atrioversion may offer an interesting alternative in the future. However, there remain some significant limitations, such as the pain associated with low-energy shocks, the risk of ventricular fibrillation induction and the cost-benefit issue which needs to be solved before this technique can become clinically applicable. Last but not least, transcatheter radio frequency ablation of atrial fibrillation, a still highly investigational technique, may have the potential to revolutionize interventional therapy of atrial fibrillation in the future. For this to occur, however, the technique still needs significant improvement. In conclusion, although their current impact on clinical practice is rather small, interventional techniques for treatment of atrial fibrillation are rapidly developing and will certainly change our therapeutic strategies in the near future.

Atrial Fibrillation↗
PubMed1996

[Risk stratification following myocardial infarct].

In recent decades, early mortality of acute myocardial infarction has decreased from above 30% to below 10%. Many survivors of acute myocardial infarction are at increased risk for cardiac death and/or nonfatal recurrent ischemic events. This has not changed with the introduction of thrombolysis. How can high risk patients be identified who would benefit from coronary revascularization and/or from antiarrhythmic treatment? Based on clinical findings such as a large infarction, infarction of the anterior wall, congestive heart failure, cardiogenic shock during the acute phase, post-infarct angina and a history of previous infarctions, high risk patients who should undergo coronary angiography and--if feasible--revascularization can be defined. Patients with symptomatic arrhythmias should receive medical or interventional antiarrhythmic treatment. All patients who are clinically considered not to be at high risk should undergo risk stratification with signal averaged ECG, non-invasive stress testing and non-invasive quantification of left ventricular function. In the presence of late potentials, ischemia during stress testing and impaired left ventricular function, further evaluation with Holter ECG or an electrophysiologic study and coronary angiography is indicated. In infarct survivors over 75 years old, the therapeutic goal is improvement of quality of life, i.e. relief of symptoms, rather than improvement of prognosis. Invasive procedures should therefore be considered only in individual patients. However, in all postinfarct survivors the assessment and treatment of cardiovascular risk factors and secondary medical prevention is mandatory.

Adult↗
PubMed1996

[Cerebral ischemic events: when and how to look for a cardiac embolism source?].

In industrialized countries, cerebral ischemic events rank third among the most frequent causes of death. In survivors, long-term disability may result. The diagnosis and therapy of preventable causes is therefore a major task. Echocardiography has proven to be most helpful in the search for cardioembolic sources, and the transesophageal approach (TEE) is superior to the transthoracic (TTE) in this specific indication. In patients in whom a cardioembolic source can be identified by clinical examination, 12-lead surface ECG or chest X-ray, an additional echocardiographic examination is not necessary. Patients under 50 with cerebral ischemic events should undergo TEE. In patients over 70 with a contraindication for long-term anticoagulant therapy, TEE has no therapeutic consequences and should therefore not be performed. In patients aged between 50 and 70 the diagnostic procedure of choice must be considered in each individual patient. It should be kept in mind that a more aggressive approach using TEE, from which therapeutic conclusions are drawn, has not clearly been shown to improve the prognosis of patients with cerebral ischemic events.

Age Factors↗
PubMed1996

[Supraventricular tachycardias: mechanism, diagnosis and therapy].

Most of the paroxysmal forms of supraventricular tachycardia are reentry tachycardias in origin with either an AV-nodal reentry (AVNRT; approx. 50%) or an AV reentry circuit via accessory pathway (AVRT; approx. 30%) as the anatomical basis of tachycardia. The therapeutic options include either drug therapy or transcatheter radiofrequency ablation. In asymptomatic patients, where supra-ventricular tachycardia or WPW syndrome was documented incidentally, an expectative approach without therapy is usually recommended. However, if frequent tachycardia recurrences or severe clinical symptoms (syncope, pre-syncope make treatment mandatory, medical therapy with either betablockers, calcium antagonists or digoxin should be tried if AV-nodal reentry tachycardia is the mechanism (no evidence of WPW syndrome on the 12-lead ECG). In patients with symptomatic WPW syndrome or drug refractory AV-nodal reentry tachycardia, transcatheter radiofrequency ablation with its good results and low complication rate is the therapy of choice. The treatment modality is particularly indicated in young patients who otherwise would need lifelong drug therapy. In contrast, supraventricular tachycardias with badly defined anatomical substrate, such as multifocal atrial tachycardias or atrial fibrillation, should in the first place be treated medically and not by radiofrequency ablation.

Anti-Arrhythmia Agents↗