Transvenous radiofrequency catheter ablation for atrial flutter and atrial fibrillation: the end of the beginning?

Transvenous radiofrequency catheter ablation (RFA) for treatment of atrioventricular (AV) reentrant tachycardia and AV nodal reentrant tachycardia is remarkably successful. To the best of my knowledge, there has not been a large randomized trial comparing RFA with other treatments for these tachycardias. The lack of such trials is due at least in part to the self-evident efficacy of RFA in this setting. In turn, the efficacy of RFA for these tachycardias is in large part due to the fact that the anatomy and pathophysiology of these two tachycardias are well understood. The success of RFA for treating AV reentrant tachycardia and AV nodal reentrant tachycardia has quite rightly led to a large effort to expand this success, and thereby the indications for RFA, to other tachyarrhythmias.