Stevenson, W. G. et al. Irrigated radiofrequency catheter ablation guided by electroanatomic mapping for recurrent ventricular tachycardia after myocardial infarction: the multicenter thermocool ventricular tachycardia ablation trial. Circulation 118, 2773–2782 (2009).
Catheter ablation guided by electroanatomic mapping is now a viable treatment option to reduce episodes of recurrent ventricular tachycardia (VT) in patients who have experienced myocardial infarction. A multicenter study by William Stevenson et al. has shown that patients can be free of VT 6 months after ablation.
VT episodes can be terminated, but not prevented, using an implantable cardioverter-defibrillator. In patients with these devices, antiarrhythmic drug therapy is often administered to prevent VT; however, these agents have adverse effects and relatively poor efficacy.
Stevenson and colleagues evaluated 231 patients with recurrent episodes of monomorphic VT (median 11 in the preceding 6 months) caused by previous myocardial infarction. Ablation was carried out in all patients by means of a saline-irrigated catheter combined with electroanatomic mapping system to assist substrate mapping during sinus rhythm.
At the 6-month follow-up, 53% of patients were free of VT, and the 6-month frequency of VT episodes was reduced from a median of 11.5 to 0 in the 142 patients who had an implantable cardioverter-defibrillator before ablation. A total of 7 deaths were recorded within 7 days of the procedure and the 1-year mortality rate was 18%.
“The dramatic reduction of VT episodes after catheter ablation would likely be associated with an improved quality of life in the high-risk patients assessed in this study,” says Hugh Calkins from the Johns Hopkins Hospital in the USA.
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Richards, L. Catheter ablation can prevent VT. Nat Rev Cardiol 6, 265 (2009). https://doi.org/10.1038/nrcardio.2009.17
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DOI: https://doi.org/10.1038/nrcardio.2009.17