Radio-frequency ablation as primary management of well-tolerated sustained monomorphic ventricular tachycardia in patients with structural heart disease and left ventricular ejection fraction over 30%.
AIMS
Patients with well-tolerated sustained monomorphic ventricular tachycardia (SMVT) and left ventricular ejection fraction (LVEF) over 30% may benefit from a primary strategy of VT ablation without immediate need for a 'back-up' implantable cardioverter-defibrillator (ICD).


METHODS AND RESULTS
One hundred and sixty-six patients with structural heart disease (SHD), LVEF over 30%, and well-tolerated SMVT (no syncope) underwent primary radiofrequency ablation without ICD implantation at eight European centres. There were 139 men (84%) with mean age 62 ± 15 years and mean LVEF of 50 ± 10%. Fifty-five percent had ischaemic heart disease, 19% non-ischaemic cardiomyopathy, and 12% arrhythmogenic right ventricular cardiomyopathy. Three hundred seventy-eight similar patients were implanted with an ICD during the same period and serve as a control group. All-cause mortality was 12% (20 patients) over a mean follow-up of 32 ± 27 months. Eight patients (40%) died from non-cardiovascular causes, 8 (40%) died from non-arrhythmic cardiovascular causes, and 4 (20%) died suddenly (SD) (2.4% of the population). All-cause mortality in the control group was 12%. Twenty-seven patients (16%) had a non-fatal recurrence at a median time of 5 months, while 20 patients (12%) required an ICD, of whom 4 died (20%).


CONCLUSION
Patients with well-tolerated SMVT, SHD, and LVEF > 30% undergoing primary VT ablation without a back-up ICD had a very low rate of arrhythmic death and recurrences were generally non-fatal. These data would support a randomized clinical trial comparing this approach with others incorporating implantation of an ICD as a primary strategy.
['Maury|Philippe|P|', 'Baratto|Francesca|F|', 'Zeppenfeld|Katja|K|', 'Klein|George|G|', 'Delacretaz|Etienne|E|', 'Sacher|Frederic|F|', 'Pruvot|Etienne|E|', 'Brigadeau|Francois|F|', 'Rollin|Anne|A|', 'Andronache|Marius|M|', 'Maccabelli|Giuseppe|G|', 'Gawrysiak|Marcin|M|', 'Brenner|Roman|R|', 'Forclaz|Andrei|A|', 'Schlaepfer|Jürg|J|', 'Lacroix|Dominique|D|', 'Duparc|Alexandre|A|', 'Mondoly|Pierre|P|', 'Bouisset|Frederic|F|', 'Delay|Marc|M|', 'Hocini|Meleze|M|', 'Derval|Nicolas|N|', 'Sadoul|Nicolas|N|', 'Magnin-Poull|Isabelle|I|', 'Klug|Didier|D|', 'Haïssaguerre|Michel|M|', 'Jaïs|Pierre|P|', 'Della Bella|Paolo|P|', 'De Chillou|Christian|C|']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D017115:Catheter Ablation D016757:Death, Sudden, Cardiac D017147:Defibrillators, Implantable D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D012008:Recurrence D012189:Retrospective Studies D013318:Stroke Volume D017180:Tachycardia, Ventricular D016896:Treatment Outcome D055815:Young Adult
Radio-frequency Ablation Ventricular tachycardia Implantable cardioverter defibrillator Sudden death