A PROSPECTIVE EVALUATION OF CATHETER ABLATION OF VENTRICULAR-TACHYCARDIA AS ADJUVANT THERAPY IN PATIENTS WITH CORONARY-ARTERY DISEASE AND AN IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR

Background Implantable cardioverter-defibrillator (ICD) therapy is int egral to current therapy for ventricular tachycardia. Patients with an ICD frequently require concomitant antiarrhythmic drug therapy. Despi te this, some patients still receive frequent ICD therapies for ventri cular tachycardia. Therefore, the purpose of this prospective study wa s to determine the utility of ablation of ventricular tachycardia in p atients with an ICD who experience frequent ICD therapies. Methods and Results Twenty-one consecutive patients with frequent ICD therapies d espite antiarrhythmic drug therapy were the subjects of this study. Th e mean age was 69+/-6 years, and 17 were men. The mean ejection fracti on was 0.22+/-0.08, and all patients had coronary artery disease. Duri ng the 36+/-51 days (range, 4 days to 7 months) preceding the ablation procedures, the patients received 34+/-55 ICD therapies for the clini cal ventricular tachycardia, or a mean of 25+/-88 ICD therapies per mo nth. The patients underwent radiofrequency ablation of the presumed cl inical ventricular tachycardia by inducing the tachycardia and mapping according to endocardial activation, continuous electrical activity, pace mapping, concealed entrainment, or mid-diastolic potentials. Abla tion of the clinical arrhythmia was successful in 76% of patients duri ng 1.4+/-0.6 (range, 1 to 3) ablation procedures and required 12.5+/-9 .2 applications of energy. During 11.8+/-10.0 months of follow-up, the frequency of ICD therapies per month decreased from 60+/-80 before su ccessful ablation to 0.1+/-0.3 ICD therapies per month after ablation (P=.01). A quality-of-life assessment demonstrated a significant impro vement after successful (P=.02) but not unsuccessful ablation (P=.9). Conclusions Radiofrequency ablation of ventricular tachycardia as adju vant therapy in patients with coronary artery disease and an ICD has a reasonable success rate, significantly reduces ICD therapies, and app ears to be associated with an improved quality of life.