CATHETER ABLATION OF INCESSANT VENTRICULAR-TACHYCARDIA - ACUTE AND LONG-TERM RESULTS

Subjects Seventeen patients with incessant ventricular tachycardia ref ractory to anti-arrhythmic therapy underwent catheter ablation between 1987 and 1993. Fifteen patients had coronary heart disease and two ha d dilated cardiomyopathy. The mean age of the patients was 65 +/- 8 an d the mean left ventricular ejection fraction was 31 +/- 9%. Methods A blation sites were selected on the basis of endocardial activation map ping, concealed entrainment or bundle branch mapping. Catheter ablatio n was performed with direct current in nine patients and with radiofre quency energy in eight patients. Incessant ventricular tachycardia was terminated by catheter ablation in all 17 patients. Results One patie nt died after the ablation procedure due to pericardial tamponade. Dur ing electrophysiological testing 5-14 days later, 7 of 16 patients (44 %) had inducible sustained or non-sustained ventricular tachycardia. F ive of them underwent implantation of an automatic cardioverter/defibr illator, and three of these experienced discharges of the device durin g a mean follow-up of 30 +/- 12 months. Another patient underwent impl antation of a cardioverter/defibrillator after spontaneous recurrence of ventricular tachycardia. Our of the nine patients without inducible ventricular tachycardia, one died as a result of sudden cardiac death , and another had spontaneous ventricular tachycardia. Thus, ventricul ar tachycardia recurred clinically in 6 of 16 patients (38%), in whom ventricular tachycardia with the same morphology as that of the ablate d ventricular tachycardia could be determined only in one patient. Con clusion Catheter ablation is the method of choice for the emergency tr eatment of patients with incessant ventricular tachycardia. Due to the high risk of recurrence, additional anti-arrhythmic management, such as the implantation of a cardioverter/defibrillator, has to be conside red.