Prophylactic catheter ablation for ventricular tachycardia reduces morbidity and mortality in patients with implantable cardioverter-defibrillator devices

摘要

Background: Although the use of implantable cardioverter-defibrillator/cardiac resynchronization therapy device with a defibrillator (ICD/CRT-D) is the principal therapy for patients with life-threatening ventricular tachyarrhythmias/ventricular fibrillation (VT/VF), prophylactic VT ablation may reduce arrhythmic episodes and mortality in patients with an ICD/CRT-D. In this retrospective study, the prognoses among patient groups with different results of attempted VT ablation were compared. Methods: The study population consisted of 151 consecutive patients with an ICD/CRT-D and structural heart disease. The mean age was 64+/-9 years, and 63 of the 151 patients were women. Of the 151 patients, 117 cases underwent catheter ablation procedure for elimination of monomorphic VT. The 151 patients were divided into 3 groups based on the results of the ablation or whether ablation was attempted, i.e., success, failure, and not-attempted groups (n=87, 30, and 34, respectively). The event rate of VT/VF and total mortality were compared among the 3 groups. Results: During a follow-up period of 31+/-22 months, VT/VF episodes and death occurred in 45 (30%) and 16 (11%) patients, respectively. When comparing the 3 groups, the rates of VT/VF episodes and death were significantly lower in the success group than in the failure and not-attempted groups (16.1%, 46.7%, 50.0%, p=0.0001 and 6.9%, 20.0%, 11.8%, p=0.0213, respectively). Conclusion: In patients with an ICD/CRT-D implant for VT/VF, prophylactic ablation of monomorphic VT may reduce morbidity and mortality.