Cardiac arrhythmias: Catheter ablation of incessant ventricular tachycardia: acute and long-term results

SUBJECTS: Seventeen patients with incessant ventricular tachycardia refractoryto anti-arrhythmic therapy underwent catheter ablation between1987 and 1993. Fifteen patients had coronary heart disease andtwo had dilated cardiomyopathy. The mean age of the patientswas 65±8 and the mean left ventricular ejection fractionwas 31±9%. METHODS: Ablation sites were selected on the basis of endocardial activationmapping, concealed entrainment or bundle branch mapping. Catheterablation was performed with direct current in nine patientsand with radiofrequency energy in eight patients. Incessantventricular tachycardia was terminated by catheter ablationin all 17 patients. RESULTS: One patient died after the ablation procedure due to pericardialtamponade. During electrophysiological testing 5–14 dayslater, 7 of 16 patients (44%) had inducible sustained or non-sustainedventricular tachycardia. Five of them underwent implantationof an automatic cardioverter/ defibrillator, and three of theseexperienced discharges of the device during a mean follow-upof 30±12 months. Another patient underwent implantationof a cardioverter/ defibrillator after spontaneous recurrenceof ventricular tachycardia. Out of the nine patients withoutinducible ventricular tachycardia, one died as a result of suddencardiac death, and another had spontaneous ventricular tachycardia.Thus, ventricular tachycardia recurred clinically in 6 of 16patients (38%), in whom ventricular tachycardia with the samemorphology as that of the ablated ventricular tachycardia couldbe determined only in one patient. CONCLUSION: Catheter ablation is the method of choice for the emergencytreatment of patients with incessant ventricular tachycardia.Due to the high risk of recurrence, additional anti-arrhythmicmanagement, such as the implantation of a cardioverter/defibrillator,has to be considered.