Surgical and Transcatheter Management of Arrhythmias

Arrhythmia surgery was originally developed as standalone therapy for medically refractory supraventricular tachycardias (SVTs) in patients with structurally normal hearts in the era prior to availability of more potent anti-arrhythmic medications such as amiodarone and flecainide, and the development of catheter ablation techniques. This chapter reviews the historical development of arrhythmia surgery, and current indications, techniques, and outcomes. Successful arrhythmia surgery is based on a clear understanding of the mechanisms of tachycardia present in an individual patient and the anatomy of the conduction system, as well as the specific operative techniques and variations available for each mechanism and anatomic variant. Prophylactic arrhythmia surgery is now an important consideration due to the significant numbers of patients with repaired congenital heart disease undergoing planned surgical reoperations, who are known to be at increased lifetime risk for developing atrial arrhythmias.