Dr.S.Venkatesan MD

Ventricular  tachycardias ,  especially incessant  ones   not controlled  by drugs are very troublesome . Radio frequency ablation  is the treatment of choice currently.  Principles of electrophysiology would demand acccurate localisation of the tachycardia  focus and then ablate it with RF energy .This requires induction of  the clinical arrhythmia on the EP table, mapping ,  identifying the circuits and ablate the optimal points  of  reentry or slow conduction or  P potentials

In reality ,  some times ( or Is it  many times !) ,  tentative ablation

in the ” V-tach Zone” without mapping  is more easier and  surprisingly more effective than the much scientific  approach of  localising the circuit and inducing the arrhythmia.This is referred to as primary ablation

Is it not a crude method to blindly burn cardiac tissues ?

No, we are not worried by the crudeness , as long as it is safe and effective. Experience have made us clever, inducing  a VT in the EP lab can be very  demanding to our senses and  it is a  true stress test for the cardiologist’s  patience  and endurance.Primary ablation has reduced fluroscopic time, procedural time and most unexpectedly  increased the success rate!

So  even a  relatively unscientific blind  burn may be  better than a scientific burn ?

Yes. It seems to be ,  at least in idiopathic VTs of fasicular   origin and  some VTs  in RVOT.

Heart is a 400gram organ , it can afford to lose few grams of tissue , especially when it is pathological  and behave aberrantly

Reference:

A nice paper from India

Anoop Gupta K  Primary radiofrequency ablation for incessant idiopathic ventricular tachycardia : Pacing and clinical electrophysiology 2002, vol. 25, 1555-1560