Patients with ventricular tachycardia or ventricular fibrillation do better if they undergo catheter ablation before receiving an implantable cardioverter defibrillator, according to a study of 107 patients.
Patients in the prospective, randomized controlled Ventricular Tachycardia Ablation in Coronary Heart Disease (VTACH) study were included if they had previous myocardial infarction, stable ventricular tachycardia, and a left ventricular ejection fraction of 50% or less. The investigators, led by Dr. Karl-Heinz Kuck of the Asklepios Klinik St. Georg in Hamburg, Germany, compared 52 patients who underwent catheter ablation before receiving an implantable cardioverter defibrillator (ICD) with 55 patients who received the ICD alone (Lancet 2010;375:31-40).
Patients in the ICD-alone group had a recurrence of ventricular tachycardia or ventricular fibrillation after a median of 6 months, compared with 19 months in patients who underwent ablation before ICD implantation, a significant difference. Also, 47% of patients in the ablation group had no ventricular tachycardia or fibrillation episodes within 2 years of the procedure, compared with 29% of those in the ICD-only group.
In an editorial, Dr. William G. Stevenson and Dr. Usha Tedrow of Brigham and Women's Hospital, Boston, said ablation can be “considered early, in selected patients who are receiving an [ICD] for stable ventricular tachycardia, in whom recurrences of a ventricular tachycardia are likely.” They noted, however, that catheter ablation can be risky (Lancet 2010;375:4-6).
Two patients in the ablation group experienced serious complications during the procedure—one experienced transient ischemic ST segment elevation, and another experienced a transient cerebral ischemic event.
“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,” Dr. Stevenson and Dr. Tedrow wrote.
Disclosures: The study was funded by St. Jude Medical, which manufactured and supplied all of the ICDs used in the study. Dr. Kuck acknowledged relationships with Biosense Webster, St. Jude Medical, Boston Scientific, and Medtronic. Several of the coauthors also disclosed relationships with St. Jude Medical, Sanofi-Aventis, and Biosense Webster. The editorial authors reported no relevant conflicts of interest.