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(Circulation. 1997;96:1378-1380.)
© 1997 American Heart Association, Inc.

Articles

Catheter Ablation as an Adjunct to ICD Therapy

William G. Stevenson, MD; Peter L. Friedman, MD, PhD; ; Michael O. Sweeney, MD

From the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Mass.

Correspondence to William G. Stevenson, MD, Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115. E-mail wgstevenso@bics.bwh.harvard.edu

Key Words: Editorials • ablation • myocardial infarction • tachyarrhythmias • catheter ablation

	Introduction

 
Implantable cardioverter-defibrillators (ICDs) have become a mainstay of therapy for patients with life-threatening ventricular arrhythmias.^{1 2 3} These devices provide the best "safety net" available to prevent sudden death from sustained ventricular tachycardia (VT) and ventricular fibrillation. ICDs do not prevent attacks of VT. Rather, when tachycardia occurs, sinus rhythm is restored either by antitachycardia pacing or a high-voltage shock. Antitachycardia pacing is painless and well tolerated; often the patient is unaware that it has occurred. It is usually used for slower, hemodynamically tolerated tachycardias. For hemodynamically unstable tachycardias and when antitachycardia pacing is ineffective, high-voltage cardioversion or defibrillation shocks are required. Tolerance of ICD shocks varies. Although some tachycardias can be terminated by low-energy shocks, even these usually cause severe, although brief, discomfort. Some patients are not troubled by an occasional ICD shock; for others who experience severe discomfort from the shock, the anticipation of future shocks, even when episodes of tachycardia are rare, can cause considerable emotional distress. Frequent shocks are poorly tolerated by virtually all patients. Appropriate programming of ICDs and the use of adjunct therapies to reduce ICD shocks to a tolerable level are important aspects of caring for patients who have an ICD.^{1 4 5 6} Whenever an ICD delivers antitachycardia pacing or shocks, it should be interrogated to determine whether delivery of therapy might have been inappropriate, usually the result of a supraventricular tachycardia, such as atrial fibrillation or atrial flutter.^{1 2 4} Of 65 consecutive patients who received an ICD and were followed for a median of 19 months by . . . [Full Text of this Article]

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