NONDRUG TREATMENT OF TACHYCARDIA

Anti-tachycardia drugs have the advantage of preventing recurrent arrhythmia in most cases but have the disadvantage of requiring long-term prescriptions and producing extra-cardiac and cardiac side effects. In addition, paradoxical arrhythmogenic effects sometimes occur. With the advent of radiofrequency catheter ablation and implantable defibrillators, a whole new range of indications for non-drug treatments suddenly became possible. Radiofrequency ablation is now a real alternative in cases of Wolff-Parkinson-White junctional tachycardia with intranodal re-entry and accessory pathways since the success rate is 95%. For atrial nutter and ventricular tachycardia, myocardial localizations of the causal lesions are more diffuse and the clinical success rate is lower. Consequently, since other arrhythmias may occur, ablative treatment is usually reserved for drug-resistant cases. An implantable defibrillator is the only treatment, with the exception of cases with an identifiable acute origin, for ventricular fibrillation. In many countries, defibrillators are also implanted for drug-resistant ventricular tachycardia.