Management of Patients After Catheter Ablation of Ventricular Tachycardia

The management of patients after catheter ablation of ventricular tachycardia is not well defined. In this article we summarize recently published results and report our own experience. Factors influencing the clinical outcome of these patients and methods to identify patients with an increased risk of recurrence of ventricular tachycardia are discussed. Furthermore, a review is given on current concomitant therapeutic tools including antiarrhythmic drugs and the implantation of an automatic cardioverter defibrillator.     

Standardized Assessment of Psychological Well-Being and Quality-of-Life in Patients with Implanted Defibrillators

The ICD has become a standard treatment for patients with malignant arrhythmias. Despite its benefits it may cause additional discomfort to the patients. Thus, quality-of-life needs to be assessed in these patients. Previous studies have used only small samples or unstandardized measures of quality-of-life that do not allow comparisons with other patient groups. The present study used standardized questionnaires for a cross-sectional assessment of psychological well-being and quality-of-life in ICD patients and to compare them to a similar group of coronary artery disease (CAD) patients without ICD. Overall, quality-of life did not differ between both groups, ICD patients being less anxious than the CAD group. With increasing numbers of ICD shocks, however, the percentage of psychologically distressed ICD patients rose from 10% to > 50%. Psychologically distressed patients had significantly worse scores on most of the quality-of-life subscales, showed less treatment satisfaction, and more negative attitudes. It is concluded that ICD patients have an acceptable mean quality-of-life and low mean anxiety. However, a relevant subgroup of about 15%, especially patients with frequent shocks, experience psychological distress and reduced quality-of-life and should receive special care.     

The Effect of Coronary Bypass Graft Surgery for the Prevention of Sudden Cardiac Death: Recurrent Episodes After ICD Implantation and Review of Literature

Sudden cardiac death (SCD) accounts for at least 50% of the mortality of patients with ischemic heart failure. Ventricular arrhythmias are responsible for most cases of sudden cardiac death. There is some evidence that coronary artery bypass graft (CABG) surgery may reduce the incidence of recurrent episodes of SCD by prevention of myocardial ischemia. To test the hypothesis that CABG surgery is effective in the prevention of SCD, we compared the recordings of implantable cardioverter defibrillators (ICD) in patients who underwent ICD implantation alone (n = 64) or ICD implantation and concomitant CABG surgery respectively (n = 11). All patients had experienced out of hospital cardiac arrest. ICD recordings were obtained every 3 months and the number of recurrent episodes of ventricular tachycardia (VT) for each time period was noted. Three months foilowing ICD implantation patients in the surgically treated group had an average of one episode of VT per patient as compared to 2.7 episodes in the nonsurgical group. This difference was observed during the following months as well. However, at nlo time (up to 18 months of follow-up) this difference reached statistical significance. There were no deaths in the surgically treated group. Although we could not demonstrate a statistical significant difference between the two groups, there was a tendency in the surgically treated group to have less episodes of recurrent VT than in the medically treated group. We, therefore, conclude that survivors of SCD presenting with multivessel coronary artery disease (CAD) should undergo coronary artery bypass grafting to prevent myocardial ischemia as the triggering event for lethal ventricular arrhythmias.     

Implantable Cardioverter Defibrillator Detection During Radiofrequency Catheter Ablation of Ventricular Tachycardia

Right ventricular radiofrequency catheter ablation was performed in an ICD patient with frequent ventricular tachycardia without prior inactivation of the device. The registrations of inlracardiac ECG and marker channel were excellent during energy delivery: the surface ECG was affected. The device did not show dysfunction during and after energy delivery.