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(Circulation. 2007;115:2750-2760.)
© 2007 American Heart Association, Inc.

Interventional Cardiac Electrophysiology

Catheter Ablation for Ventricular Tachycardia

William G. Stevenson, MD; Kyoko Soejima, MD

From the Department of Internal Medicine, Cardiovascular Division, Brigham and Women’s Hospital, Boston, Mass (W.G.S.), and Cardiovascular Division, Department of Internal Medicine, Keio University Hospital, Tokyo, Japan (K.S.).

Correspondence to William G. Stevenson, MD, Cardiovascular Division, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115. E-mail wstevenson@partners.org

Key Words: ablation • arrhythmia • cardiomyopathy • myocardial infarction • tachyarrhythmias

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Sustained ventricular tachycardia (VT) is an important cause of morbidity and sudden death in patients with heart disease.¹ Implantable cardioverter-defibrillators (ICDs) terminate VT episodes, reducing the risk of sudden death. Recurrent VT develops in 40% to 60% of patients who receive an ICD after an episode of spontaneous sustained VT. A first episode of VT occurs in 20% of patients within 3 to 5 years after ICD implantation for primary prevention of sudden death in high-risk groups.^2–4 ICD shocks reduce quality of life and are associated with an increased risk of death.^2–4 Antiarrhythmic drug therapy with amiodarone or sotalol reduces VT episodes but with disappointing incidence of side effects and efficacy.² Catheter ablation is useful for reducing VT episodes and can be life-saving when VT is incessant.^1,5,6

Idiopathic VTs occur in patients without structural heart disease and rarely cause sudden death. Electrophysiological study with catheter ablation is often warranted to confirm the diagnosis, to provide further evidence for the absence of ventricular scar or other disease, and often to cure the arrhythmia. Ablation is also an option for symptomatic nonsustained VT and frequent ventricular ectopy in these patients.¹

The appearance of the VT on ECG often suggests its likely cause and associated heart disease (Figure 1). Monomorphic VT has the same QRS complex from beat to beat, indicating repetitive ventricular activation from a structural substrate or focus that can be targeted for ablation. Most are due to reentry through regions of ventricular scar.⁷

View larger version (42K):   Figure 1. ECG types of . . . [Full Text of this Article]

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