Long-term clinical outcome of patients with prior myocardial infarction after palliative radiofrequency catheter ablation for frequent ventricular tachycardia

Patients with coronary artery disease and hemodynamically tolerated, highly frequent, sustained monomorphic ventricular tachycardia (VT) may undergo r adiofrequency catheter ablation (RFCA) for elimination of greater than or e qual to1 morphologically distinct Vis. The purpose of this study was to eva luate the lone-term clinical benefit following RFCA as a palliative treatme nt of highly frequent or incessant ischemic VT. Fifty-five patients underwe nt RFCA of 62 VTs. The target VT was successfully ablated in 82% of patient s. Complication and perioperative mortality rates were 7.2% and 1.8%, respe ctively. At 5 years, total mortality was 51% and probability of freedom fro m all ventricular tachyarrhythmias was 28%. All patients had highly frequen t or incessant drug-refractory VT before RFCA. Clinical benefit was defined as either freedom from all ventricular tachyarrhythmias, or a reduction in frequency of recurrence from >1 episode per month before RFCA to greater t han or equal to1 episode per year of any ventricular tachyarrhythmia, inclu ding all appropriate implantable cardioverter defibrillator (ICD) therapies . By this definition, 54% of the patients continued to benefit from RFCA at 5 years. Of 19 variables analyzed with a Cox univariate model, only the pr esence of a left ventricular aneurysm and a previously implanted ICD were p redictive of any ventricular arrhythmia recurrence. However, at 5 years ove r half of the surviving patients still continued to benefit from RFCA of th eir clinical VT. Because the overall rate of any ventricular tachyarrhythmi a occurrence during follow-up is high, additional protection, such as an IC D, is required. (C) 2001 by Excerpta Medico, Inc.