CATHETER ABLUTION OF VENTRICULAR-TACHYCARDIA IN 136 PATIENTS WITH CORONARY-ARTERY-DISEASE - RESULTS AND LONG-TERM FOLLOW-UP

Objectives. This study attempted to determine the feasibility and long -term efficacy of catheter ablation by means of either radiofrequency or direct current energy in a selected group of patients with coronary artery disease. Background. Catheter ablation of ventricular tachycar dia has proved to be highly effective in patients with idiopathic and bundle branch reentrant ventricular tachycardia. In patients with coro nary artery disease and recurrent sustained ventricular tachycardia re sistant to medical antiarrhythmic management, the value of catheter ab lation has not yet been established. Methods. One hundred thirty-six p atients with coronary artery disease and one configuration of monomorp hic sustained ventricular tachycardia underwent radiofrequency (72 pat ients) or direct current catheter ablation (64 patients), The mapping procedure to localize an adequate site for ablation included pace mapp ing during sinus rhythm, endocardial activation mapping, identificatio n of isolated mid diastolic potentials and pacing interventions during ventricular tachycardia. Results. Primary success was achieved in 102 (75%) of 136 patients (74% of 72 undergoing radiofrequency and 77% of 64 with direct current ablation). Complications were noted in 12% of patients. During a mean (+/- SD) follow-up period of 24 +/- 13 months (range 3 to 68), ventricular tachycardia recurred in 16% of patients. Conclusions. Catheter ablation of ventricular tachycardia in coronary artery disease is feasible in patients with one configuration of monom orphic sustained ventricular tachycardia. There is no significant diff erence with respect to the type of energy applied. The follow-up data show that in a selected group of patients with coronary artery disease , catheter ablation offers a therapy alternative.