After the cause of the arrhythmia is diagnosed, should I first treat it with medication and only consider radiofrequency ablation if it is not effective? Not necessarily, it depends on which arrhythmia is present. If it is a supraventricular tachycardia, the cause of which is the presence of a congenital atrioventricular bypass or a double pathway in the AV node, drug therapy is not effective, the effect cannot be maintained over time, and it is not possible to take drugs for life. If the tachycardia occurs more than twice, and the patient has significant symptoms, radiofrequency ablation can be considered. In the case of paroxysmal atrial fibrillation, it is generally advocated to take an antiarrhythmic drug first, and if it does not work, then radiofrequency ablation can be done. However, several recent clinical studies have also found that there are no particularly effective and safe antiarrhythmic drugs for atrial fibrillation. For paroxysmal atrial fibrillation, radiofrequency ablation can be used directly without attempting antiarrhythmic drug therapy. In addition, atrial tachycardia and atrial flutter can be treated directly by catheter radiofrequency ablation, which can also achieve very good results. The success rate of transcatheter ablation is more than 95% for atrial tachycardia and atrial flutter due to its mature technology and high success rate. Are there any requirements for the age and condition of the patient to undergo radiofrequency ablation? First of all, the patient’s condition must meet the indications for catheter ablation, i.e., he/she has the above mentioned tachyarrhythmias and is diagnosed by the physician as requiring ablation. As for the restrictions of individual conditions, they vary from person to person and from disease to disease and need to be treated individually. Whether an arrhythmia can be ablated by radiofrequency depends firstly on whether the disease is recurrent and secondly on whether there is another underlying disease that will affect the patient’s life expectancy. If the life expectancy is less than one year, then the general consensus is not to do radiofrequency ablation. If the life expectancy is still three to five years, then it should be done. Thirdly, if the arrhythmia causes harm to the patient, for example, some patients have recurrent episodes of ventricular tachycardia, hypotension and shock, and the medication does not work, even if it is risky, radiofrequency ablation should be used to try to get rid of the ventricular tachycardia. Even if the ventricular tachycardia cannot be completely eliminated, efforts should be made to change the basis of the onset of ventricular tachycardia so that its episodes become less frequent and the ventricular rate slows down during the episodes. In the case of supraventricular tachycardia, for example, most patients do not have clear underlying organic heart disease, and if they do have underlying heart disease, they can be considered for multiple ablations as long as the patient can lie flat for half an hour to an hour. For this group of patients, there is no age limit. The literature reports that people as young as about 1 year old and as old as 100 years old have undergone radiofrequency ablation. Because atrial fibrillation itself is a disease of the elderly, most patients are in their seventies. Among the patients we have completed transcatheter ablation of atrial fibrillation, the oldest was 91 years old and the youngest was 12 years old. Postoperative follow-up was 4 and 2.5 years, respectively, and successful catheter ablation of atrial fibrillation was found to be a completely normal quality of life for the patients. It is evident that in most cases, age is not an absolute condition limiting transcatheter ablation procedures. In the case of atrial fibrillation combined with other heart disease, such as heart failure, the management should be individualized. If the patient has atrial fibrillation and then heart failure, the benefit of doing radiofrequency ablation is greater. Because once atrial fibrillation is well, heart failure can also improve. If the patient has chronic heart failure first and then has atrial fibrillation, it should be combined with the degree of heart failure. 50% of heart failure patients with class II or III heart function have a 5-year survival rate, and if atrial fibrillation is not long, the left atrium is not very large, and the occurrence of atrial fibrillation is an important factor in the patient’s heart failure exacerbation, catheter ablation of atrial fibrillation can be considered in an experienced center with optimal drug therapy; if the heart failure patient If the heart failure patient’s heart function has progressed to class III or IV, and the one-year survival rate is 20-30%, in this case, it is not very meaningful to do RF ablation. Are there any contraindications to radiofrequency ablation? There are contraindications to any procedure. A thrombus in the left atrium of a patient with atrial fibrillation is a contraindication to catheter ablation, as the catheter may touch the thrombus and lead to embolism, which is fatal, especially if it is a newly formed thrombus, so radiofrequency ablation is definitely not indicated. Patients with other arrhythmias, such as thrombus in the heart chambers, are also contraindications to catheter ablation. Patients with severe bleeding tendencies are also contraindications to ablation, such as particularly low platelets and severe bleeding disorders. If the tachycardia originates from the left atrium or left ventricle, the catheter may also need to be delivered through the artery or through the septum via the vein. How effective is radiofrequency ablation in treating arrhythmias? It depends on the type of arrhythmia. For example, for paroxysmal supraventricular tachycardia such as atrioventricular node folding tachycardia and pre-excitation syndrome, the success rate of primary radiofrequency ablation in experienced centers is more than 99%, and the recurrence rate is about 1-2%. Even if recurrence occurs, the success rate is still more than 99% with another RF ablation. The success rate of transcatheter ablation for complex arrhythmias such as atrial tachycardia, atrial flutter, ventricular premature, and idiopathic ventricular tachycardia is also over 90%. The success rate of radiofrequency ablation of atrial fibrillation is slightly lower. Among them, the success rate of paroxysmal atrial fibrillation is about 80%, and the success rate of persistent atrial fibrillation is about 60%, and sometimes multiple ablations are needed, which is determined by the characteristics of this disease. How to judge the success of radiofrequency ablation? Is it based on the disappearance of symptoms? To be precise, there are no symptoms associated with the tachycardia to be treated by RF ablation, and no asymptomatic tachycardia is recorded by long-range ECG monitoring. For example, if there are no symptoms associated with supraventricular tachycardia after radiofrequency ablation is taken for supraventricular tachycardia, then the radiofrequency ablation is considered successful. However, if the patient has other cardiovascular disease in combination, other symptoms may be present. The criteria for successful ablation of atrial fibrillation are the absence of symptoms associated with atrial fibrillation and the duration of recorded episodes of asymptomatic atrial fibrillation, atrial flutter and atrial tachycardia of less than 30 seconds.