| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 1997;96:1525-1531.)
© 1997 American Heart Association, Inc.
Articles |
A Prospective Evaluation of Catheter Ablation of Ventricular Tachycardia as Adjuvant Therapy in Patients With Coronary Artery Disease and an Implantable Cardioverter-Defibrillator
From the Division of Cardiology, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor.
Correspondence to S. Adam Strickberger, MD, University of Michigan Medical Center, 1500 E Medical Center Dr, Box 0022, Ann Arbor, MI 48109-0022.
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.
Key Words: implantable cardioverter-defibrillator • catheter ablation • coronary artery disease • tachycardia
This article has been cited by other articles:
 |
|
 |
|
  F. Sacher, U. B. Tedrow, M. E. Field, J.-M. Raymond, B. A. Koplan, L. M. Epstein, and W. G. Stevenson Ventricular Tachycardia Ablation: Evolution of Patients and Procedures Over 8 Years Circ Arrhythm Electrophysiol, August 1, 2008; 1(3): 153 - 161. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Carbucicchio, M. Santamaria, N. Trevisi, G. Maccabelli, F. Giraldi, G. Fassini, S. Riva, M. Moltrasio, M. Cireddu, F. Veglia, et al. Catheter Ablation for the Treatment of Electrical Storm in Patients With Implantable Cardioverter-Defibrillators: Short- and Long-Term Outcomes in a Prospective Single-Center Study Circulation, January 29, 2008; 117(4): 462 - 469. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Almendral and M. E. Josephson All Patients With Hemodynamically Tolerated Postinfarction Ventricular Tachycardia Do Not Require an Implantable Cardioverter-Defibrillator Circulation, September 4, 2007; 116(10): 1204 - 1212. [Full Text] [PDF]
|
|
|
|
|
|
A. Arenal, S. del Castillo, E. Gonzalez-Torrecilla, F. Atienza, M. Ortiz, J. Jimenez, A. Puchol, J. Garcia, and J. Almendral Tachycardia-Related Channel in the Scar Tissue in Patients With Sustained Monomorphic Ventricular Tachycardias: Influence of the Voltage Scar Definition Circulation, October 26, 2004; 110(17): 2568 - 2574. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Bansch, F. Steffgen, G. Gronefeld, C. Wolpert, D. Bocker, R.-U. Mletzko, W. Schols, K. Seidl, M. Piel, F. Ouyang, et al. The 1+1 Trial: A Prospective Trial of a Dual- Versus a Single-Chamber Implantable Defibrillator in Patients With Slow Ventricular Tachycardias Circulation, August 31, 2004; 110(9): 1022 - 1029. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. B. Curtis Filling the need for new antiarrhythmic drugs to prevent shocks from implantable cardioverter defibrillators J. Am. Coll. Cardiol., January 7, 2004; 43(1): 44 - 46. [Full Text] [PDF]
|
|
|
|
|
|
V. Y. Reddy, P. Neuzil, M. Taborsky, and J. N. Ruskin Short-term results of substrate mapping and radiofrequency ablation of ischemic ventricular tachycardia using a saline-irrigated catheter J. Am. Coll. Cardiol., June 18, 2003; 41(12): 2228 - 2236. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Brugada, A. Berruezo, A. Cuesta, J. Osca, E. Chueca, X. Fosch, L. Wayar, and L. Mont Nonsurgical transthoracic epicardial radiofrequency ablation: An alternative in incessant ventricular tachycardia J. Am. Coll. Cardiol., June 4, 2003; 41(11): 2036 - 2043. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y. Mahomed and J. M. Miller Return cycle mapping: Have we come full cycle? J. Thorac. Cardiovasc. Surg., March 1, 2003; 125(90030): S17 - 19. [Full Text] [PDF]
|
|
|
|
|
|
A. Arenal, E. Glez-Torrecilla, M. Ortiz, J. Villacastin, J. Fdez-Portales, E. Sousa, S. del Castillo, L. Perez de Isla, J. Jimenez, and J. Almendral Ablation of electrograms with an isolated, delayed component as treatment of unmappable monomorphic ventricular tachycardias in patients with structural heart disease J. Am. Coll. Cardiol., January 1, 2003; 41(1): 81 - 92. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Strohmer and C. Hwang Ablation of postinfarction ventricular tachycardia guided by isolated diastolic potentials Europace, January 1, 2003; 5(4): 375 - 380. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. O'Donnell, J.P. Bourke, R. Anilkumar, E. Simeonidou, and S.S. Furniss Radiofrequency ablation for post infarction ventricular tachycardia. Report of a single centre experience of 112 cases Eur. Heart J., November 1, 2002; 23(21): 1699 - 1705. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Soejima and W. G. Stevenson Ventricular Tachycardia Associated With Myocardial Infarct Scar: A Spectrum of Therapies for a Single Patient Circulation, July 9, 2002; 106(2): 176 - 179. [Full Text] [PDF]
|
|
|
|
|
|
P. A. Friedman, S. J. Asirvatham, S. Grice, M. Glikson, T. M. Munger, R. F. Rea, W. K. Shen, A. Jahanghir, D. L. Packer, and S. C. Hammill Noncontact mapping to guide ablation of right ventricular outflow tract tachycardia J. Am. Coll. Cardiol., June 5, 2002; 39(11): 1808 - 1812. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P Mazeika Aborted sudden cardiac death: a clinical perspective Postgrad. Med. J., June 1, 2001; 77(908): 363 - 370. [Abstract] [Full Text]
|
|
|
|
|
|
K. Soejima, E. Delacretaz, M. Suzuki, C. B. Brunckhorst, W. H. Maisel, P. L. Friedman, and W. G. Stevenson Saline-Cooled Versus Standard Radiofrequency Catheter Ablation for Infarct-Related Ventricular Tachycardias Circulation, April 10, 2001; 103(14): 1858 - 1862. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Mahomed and J. M. Miller Return cycle mapping: Have we come full cycle? J. Thorac. Cardiovasc. Surg., February 1, 2001; 121(2): 0197 - 199. [Full Text] [PDF]
|
|
|
|
 |
|
 D W. DAVIES Catheter ablation of ventricular tachycardia: are there limits? Heart, December 1, 2000; 84(6): 585 - 586. [Full Text]
|
|
|
|
|
|
S Furniss, R Anil-Kumar, J P Bourke, R Behulova, and E Simeonidou Radiofrequency ablation of haemodynamically unstable ventricular tachycardia after myocardial infarction Heart, December 1, 2000; 84(6): 648 - 652. [Abstract] [Full Text]
|
|
|
|
|
|
W. G Stevenson and E. Delacretaz ELECTROPHYSIOLOGY: Radiofrequency catheter ablation of ventricular tachycardia Heart, November 1, 2000; 84(5): 553 - 559. [Full Text]
|
|
|
|
|
|
D. Bansch, M. Castrucci, D. Bocker, G.u. Breithardt, and M. Block Ventricular tachycardias above the initially programmed tachycardia detection interval in patients with implantable cardioverter-defibrillators: Incidence, prediction and significance J. Am. Coll. Cardiol., August 1, 2000; 36(2): 557 - 565. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Bansch, D. Bocker, J.u. Brunn, M. Weber, G.u. Breithardt, and M. Block Clusters of ventricular tachycardias signify impaired survival in patients with idiopathic dilated cardiomyopathy and implantable cardioverter defibrillators J. Am. Coll. Cardiol., August 1, 2000; 36(2): 566 - 573. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Korte, W. Jung, G. Ostermann, C. Wolpert, S. Spehl, B. Esmailzadeh, and B. Luderitz Hospital readmission after transvenous cardioverter/defibrillator implantation. A single centre study Eur. Heart J., July 2, 2000; 21(14): 1186 - 1191. [Abstract] [PDF]
|
|
|
|
|
|
H. Calkins, A. Epstein, D. Packer, A. M. Arria, J. Hummel, D. M. Gilligan, J. Trusso, M. Carlson, R. Luceri, H. Kopelman, et al. Catheter ablation of ventricular tachycardia in patients with structural heart disease using cooled radiofrequency energy: Results of a prospective multicenter study J. Am. Coll. Cardiol., June 1, 2000; 35(7): 1905 - 1914. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. A. Strickberger, B. P. Knight, G. F. Michaud, F. Pelosi, and F. Morady Mapping and ablation of ventricular tachycardia guided by virtual electrograms using a noncontact, computerized mapping system J. Am. Coll. Cardiol., February 1, 2000; 35(2): 414 - 421. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Calkins, J. T. Bigger Jr, S. J. Ackerman, S. B. Duff, D. Wilber, R. A. Kerr, M. Bar-Din, K. M. Beusterien, and M. J. Strauss Cost-Effectiveness of Catheter Ablation in Patients With Ventricular Tachycardia Circulation, January 25, 2000; 101(3): 280 - 288. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. El-Shalakany, T. Hadjis, P. Papageorgiou, K. Monahan, L. Epstein, and M. E. Josephson Entrainment/Mapping Criteria for the Prediction of Termination of Ventricular Tachycardia by Single Radiofrequency Lesion in Patients With Coronary Artery Disease Circulation, May 4, 1999; 99(17): 2283 - 2289. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Morady Radio-Frequency Ablation as Treatment for Cardiac Arrhythmias N. Engl. J. Med., February 18, 1999; 340(7): 534 - 544. [Full Text] [PDF]
|
|
|
|
|
|
W. G. Stevenson, P. L. Friedman, and M. O. Sweeney Catheter Ablation as an Adjunct to ICD Therapy Circulation, September 2, 1997; 96(5): 1378 - 1380. [Full Text]
|
|