Catheter ablation for atrial fibrillation: Hartford Hospital experience.

Historical Perspective A appreciation of symptoms related to alterations in heart function is not new. Ancient chinese physicians studied the relationship of the palpable pulse to health as early as the fifth century B.C. Manipulation and/or eradication of symptomatic or harmful cardiac arrhythmias date back to the 7th and 8th centuries when natural pharmacology was used: quinine to quell the fibrillating atria, and foxglove to treat cardiac insufficiency. After some success with these attempts at controlling heart rhythm through pharmacology, a huge discipline and industry was created. unfortunately, over the ensuing decades, it was learned that these limited successes also had a price. While some patients did quite well and remained free from their symptomatic arrhythmias, many patients succumbed to the unknown evils of products that were poorly understood and even more poorly tested and evaluated. The first published attempt to surgically alter the heart, and thereby prevent a cardiac arrhythmia was reported in 959. despite this surgical failure to prevent recurrent ventricular tachycardia, a new and aggressive approach to controlling cardiac arrhythmias was born. it took Guiraudon, and colleagues, another 5 years to describe a surgical procedure aimed not specifically at the arrhythmiaventricular tachycardia—but at its substrate—a dilated cardiomyopathy.2 in this same decade, in both europe and America, the development of electrophysiologic-programmed stimulation techniques enabled animal and human studies of multiple arrhythmias, including monomorphic ventricular tachycardia.3,4 With the development of standardized electrophysiologic benchmarks, and the advancement of open heart surgical techniques through the 970s and into the 80s, a collaborative effort between electrophysiologists and surgeons developed. in 978, Josephson and colleagues reported the first EP map guided endocardial resection procedure for sustained VT—the first successful nonpharmacologic therapy for a cardiac arrhythmia.5 the era of eP guided nonpharmacological arrhythmia management was born.