Abstract 11558: Prophylactic Catheter Ablation for Induced Ventricular Tachycardia in Patients with Implantable Cardioverter Defibrillators as the Primary Prevention
Background: Implantable cardioverter defibrillators (ICDs) are the mainstay of therapy for preventing sudden cardiac deaths. However, ICD shocks are painful and can result in worsening Quality of Life. Previous studies have shown that prophylactic catheter ablation (CA) for arrhythmogenic ventricular tissues reduce the incidence of ICD therapy in secondary prevention patients. However, it is unknown whether prophylactic CA for induced ventricular tachycardia (VT) reduces the incidence of ICD therapy in primary prevention patients.
Methods: We retrospectively investigated 58 consecutive patients with structural heart diseases who received ICD implants as the primary prevention between 1996 and 2010. They had undergone electrophysiological testing prior to the ICD implantation. Of these patients, patients without inducible VTs and patients with Hypertrophic cardiomyopathy were excluded from the study. Total of 40 patients were included for the study. They were divided into 2 groups; (A) those who received prophylactic CA for induced VT (n = 17), and (B) did not receive CA (n = 23). Endocardial CA was performed using conventional and substrate mapping.
Results: Twenty-nine ischemic cardiomyopathy and 11 non-ischemic cardiomyopathy patients were included. In all patients, average of 2.0 VTs were induced and targeted for ablation (range 1 to 4). There were no differences in the left ventricular ejection fraction (LVEF) (32 ± 11% vs. 36 ± 11%, P = NS), New York Heart Association class (1.6 ± 0.6 vs. 1.7 ± 0.6, P = NS), HV time (52 ± 11msec vs. 51 ± 13msec, P = NS), number of induced VTs (1.9 ± 1.1 vs. 2.0 ± 1.3, P = NS) between the 2 groups. During a mean follow-up of 52 ± 40 months, 15 patients (37.5%) experienced appropriate ICD therapy (shock or antitachycardia pacing). Two patients (11%) experienced ICD therapy in Group A and 13 (56%) in Group B. Group A experienced significantly less appropriate ICD therapy than Group B (OR 0.10; 95% CI 0.01-0.55; P = 0.004). Inappropriate therapy was observed 4 patients in Group A and 7 in Group B. (23% vs. 30%, P = NS).
Conclusion: In this retrospective small study, prophylactic CA for induced sustained VT reduced the incidence of appropriate ICD therapy in patients with low LVEF who received ICDs for the primary prevention.
- Catheter ablation
- Ventricular tachycardia
- Implantable cardioconvert defibrillator
- © 2011 by American Heart Association, Inc.