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| |  Catheter Ablation Prior to Defibrillator Shock Reduces Risk of Ventricular Tachycardia Recurrence NEW YORK -- January 4, 2010 -- A study published in a recent issue of The Lancet shows that use of catheter ablation prior to implantable cardioverter defibrillator (ICD) implantation reduces the risk of ventricular tachycardia (VT) recurrence at 2 years. Patients who receive ICD shocks have a decreased quality of life (especially if 5 or more shocks per year are delivered) and increased mortality compared with patients who do not receive shocks. Furthermore, ICDs do not prevent sudden cardiac death in 3% to 7% of patients. Drug treatment can reduce the number of ICD interventions, but lifetime intake is necessary and it is associated with serious adverse events. The Ventricular Tachycardia Ablation in Addition to Implantable Defibrillators in Coronary Heart Disease (VTACH) study was designed to assess prophylactic VT ablation followed by implantation of a cardioverter defibrillator in patients with previous myocardial infarction, first episode of stable VT, and reduced left-ventricular function. In the multicentre, international, randomised controlled trial Karl-Heinz Kuck, MD, Asklepios Klinik St Georg, Hamburg, Germany, and colleagues assessed 107 eligible patients aged 18 to 80 years. Of the patients, 52 were assigned to ablation plus ICD, and 55 to ICD only. Mean follow-up was 22.5 months. The researchers found that time to recurrence of VT or VF was longer in the ablation group (median 19 months) than in the control group (6 months). At 2 years, estimates for survival free from VT or VF were 47% in the ablation group and 29% in the control group -- meaning that patients given ablation plus ICD were around 40% less likely to experience repeat VT or VF than those given ICD only. Complications related to the ablation procedure occurred in 2 patients; no deaths occurred within 30 days after ablation. A total of 15 device-related complications requiring surgical intervention occurred in 13 patients (ablation group, 4; control group, 9). Nine patients died during the study (ablation group, 5; control group, 4). “Prophylactic VT ablation before defibrillator implantation seemed to prolong time to recurrence of VT in patients with stable VT, previous myocardial infarction, and reduced LVEF. Prophylactic catheter ablation should therefore be considered before implantation of a cardioverter defibrillator in such patients,” the authors wrote. In an accompanying comment, William G. Stevenson, MD, and Usha Tedrow, MD, Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts, said: “Implantable defibrillators are a life-saving safety-net for patients with sustained ventricular tachycardia late after myocardial infarction. The VTACH trial suggests that ablation be considered early, in selected patients who are receiving an implantable cardioverter defibrillator for stable ventricular tachycardia, in whom recurrences of a ventricular tachycardia are likely. Evidence of a positive effect on survival, subsequent hospital admissions, or quality of life is needed before this strategy can be recommended for routine use. We believe that today’s trial is further evidence to support early use of catheter ablation, as an alternative to antiarrhythmic drug therapy, for symptomatic recurrent ventricular tachycardia after implantation of an implantable cardioverter defibrillator, provided that the expertise to safely perform the procedure is available.”
SOURCE: The Lancet
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