Risks and Benefits of Catheter Ablation of Ventricular Tachycardia in Patients with an Implantable Cardioverter-Defibrillator

Abstract

Patients with an implantable cardioverterdefibrillator (ICD) may receive frequent shocks or antitachycardia pacing for monomorphic ventricular tachycardia despite suppressive drug therapy. Antitachycardia pacing is often well-tolerated but not always effective. High voltage cardioversion is usually painful and may cause severe, disabling anxiety for some patients. Therefore, catheter ablation is an important adjunct to medical therapy for patients with structural heart disease who have frequent shocks for episodes of ventricular tachycardia. In 56‐100% of selected patients, hemodynamically-tolerated monomorphic ventricular tachycardia can be successfully ablated with radiofrequency energy and standard mapping techniques [1‐6]. Herein we review the indications, benefits and risks of radiofrequency ablation of monomorphic ventricular tachycardia for patients with structural heart disease and an ICD. Willems et al. [4] published the first series of patients with catheter ablation of monomorphic ventricular tachycardia as an adjunct to ICD therapy. Among 6 patients, 5 had monomorphic ventricular tachycardia originating in a healed myocardial scar related to coronary artery disease and the other patient had bundle branch reentry. Four of 6 patients had incessant monomorphic ventricular tachycardia at the time of the procedure and the remaining 2 had frequent ICD shocks. The monomorphic ventricular tachycardia in all patients was successfully ablated, but 2 of 6 patients continued to have relatively frequent ICD shocks during the follow-up period.