Ablative Therapies in Arrhythmia Emergencies

Most cardiac ablation procedures for arrhythmias are elective, as their pathophysiology is slowly evolving and initially manifests with occasional episodes interspersed with long periods of normal heart rhythm. Atrial fibrillation, the most common sustained cardiac arrhythmia, is typically associated with chronic, slowly maturing changes in the electrophysiological properties and anatomy of the atrial myocardium. Clinical cardiac electrophysiologists occasionally encounter cardiac arrhythmias that require a procedural approach. The modality of cardiac ablation that is currently most frequently employed consists of applications of radiofrequency ablation (RFA) energy via catheters introduced percutaneously. Additional antiarrhythmic drugs often cannot be safely added as they may exert negative inotropic activity. A small case series suggests that left cardiac sympathetic denervation (LCSD) may be an effective addition to the treatment of refractory ventricular arrhythmias in structural heart disease if other modalities are unsuccessful and it could be used as a bridge to a final therapy.