Ablation for Ventricular Tachycardia During Stable Sinus Rhythm

Implantable cardioverter defibrillators (ICDs) can effectively terminate ventricular tachycardia (VT) when it occurs, but do not prevent initiation of VT. There are several reasons why prevention of episodes is desirable. When VT is promptly and painlessly terminated by antitachycardia pacing, it can be asymptomatic. However, patients describe defibrillator shocksas terrible events that engender fear of future shocks, and reduced quality of life1. VT episodes are associated with increased risk of mortality and heart failure hospitalizations, although it is not clear whether the arrhythmia is merely a marker for worsening heart disease, or whether episodes of VT and possibly ICD shocks actually have an adverse effect themselves1-3. Antiarrhythmic drugs, notably sotalol and amiodarone, reduce VT episodes but inefficacy and adverse effects lead to discontinuation in approximately 20% of patients, and long term toxicities are a particular concern with the most effective drug, amiodarone4-6. Catheter ablation offers the potential to prevent VT without the adverse effects of antiarrhythmic drugs, but technical challenges limit efficacy, and ablation has procedural risks7. (SELECT FULL TEXT TO CONTINUE)