A prospective evaluation of catheter ablation of ventricular tachycardia as adjuvant therapy in patients with coronary artery disease and an implantable cardioverter-defibrillator

S. Adam Strickberger*, K. Ching Man, Emile G. Daoud, Rajiva Goyal, Karin Brinkman, Carol Hasse, Frank Bogun, Bradley P. Knight, Raul Weiss, Marwan Bahu, Fred Morady

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

130 Scopus citations

Abstract

Background: Implantable cardioverter-defibrillator (ICD) therapy is integral to current therapy for ventricular tachycardia. Patients with an ICD frequently require concomitant antiarrhythmic drug therapy. Despite this, some patients still receive frequent ICD therapies for ventricular tachycardia. Therefore, the purpose of this prospective study was to determine the utility of ablation of ventricular tachycardia in patients with an ICD who experience frequent ICD therapies. Methods and Results: Twenty- one consecutive patients with frequent ICD therapies despite antiarrhythmic drug therapy were the subjects of this study. The mean age was 69±6 years, and 17 were men. The mean ejection fraction was 0.22±0.08, and all patients had coronary artery disease. During the 36±51 days (range, 4 days to 7 months) preceding the ablation procedures, the patients received 34±55 ICD therapies for the clinical ventricular tachycardia, or a mean of 25±88 ICD therapies per month. The patients underwent radiofrequency ablation of the presumed clinical ventricular tachycardia by inducing the tachycardia and mapping according to endocardial activation, continuous electrical activity, pace mapping, concealed entrainment, or mid-diastolic potentials. Ablation of the clinical arrhythmia was successful in 76% of patients during 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 successful ablation to 0.1±0.3 ICD therapies per month after ablation (P=.01). A quality-of-life assessment demonstrated a significant improvement after successful (P=.02) but not unsuccessful ablation (P=.9). Conclusions: Radiofrequency ablation of ventricular tachycardia as adjuvant therapy in patients with coronary artery disease and an ICD has a reasonable success rate, significantly reduces ICD therapies, and appears to be associated with an improved quality of life.

Original languageEnglish (US)
Pages (from-to)1525-1531
Number of pages7
JournalCirculation
Volume96
Issue number5
DOIs
StatePublished - Sep 2 1997

Keywords

  • Catheter ablation
  • Coronary artery disease
  • Implantable cardioverter-defibrillator
  • Tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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