Prophylactic Catheter Ablation for the Prevention of Defibrillator Therapy

• Published in: The New England journal of medicine Vol. 357; no. 26; pp. 2657 - 2665
• Main Authors: Reddy, Vivek Y, Reynolds, Matthew R, Neuzil, Petr, Richardson, Allison W, Taborsky, Milos, Jongnarangsin, Krit, Kralovec, Stepan, Sediva, Lucie, Ruskin, Jeremy N, Josephson, Mark E
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 27.12.2007
• Subjects: Aged; Biological and medical sciences; Cardiac arrhythmia; Cardiovascular disease; Catheter Ablation - adverse effects; Catheters; Death, Sudden, Cardiac - prevention & control; Defibrillators, Implantable - utilization; Electric Countershock - utilization; Female; Follow-Up Studies; General aspects; Heart attacks; Humans; Kaplan-Meier Estimate; Male; Medical sciences; Middle Aged; Multivariate Analysis; Myocardial Infarction - complications; Prevention and actions; Prospective Studies; Public health. Hygiene; Public health. Hygiene-occupational medicine; Tachycardia, Ventricular - etiology; Tachycardia, Ventricular - mortality; Tachycardia, Ventricular - surgery; Tachycardia, Ventricular - therapy; Ventricular Fibrillation - etiology; Ventricular Fibrillation - surgery; Medicine; Prevention; Intensive cardiocirculatory care; Therapy; Catheter; Instrumentation therapy; Defibrillation; Ablation; Defibrillator
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMoa065457

In a randomized trial, patients with a history of myocardial infarction and spontaneous ventricular arrhythmia underwent defibrillator implantation with assignment to catheter ablation of arrhythmogenic tissue or no intervention. At 22 months, 12% of patients assigned to ablation and 33% of control patients had received appropriate defibrillator therapy at least once. Patients with a history of myocardial infarction and spontaneous ventricular arrhythmia underwent defibrillator implantation with assignment to catheter ablation or no intervention. At 22 months, 12% of patients assigned to ablation and 33% of control patients had received appropriate defibrillator therapy at least once. Patients with a history of myocardial infarction who survive a spontaneous episode of ventricular arrhythmia are at high risk for subsequent sudden death from recurrent ventricular tachycardia or ventricular fibrillation. Implantable cardioverter–defibrillators (ICDs) decrease mortality and have therefore become the mainstay of treatment of these patients. 1 However, ICDs are not a cure for ventricular arrhythmias. Defibrillator discharges (shocks) for treatment of recurrent arrhythmias are painful, and syncope may occur before delivery of therapy. Clinically significant anxiety and depression as a result of recurrent ICD shocks may occur in more than 50% of patients. 2 – 4 Repeated ICD shocks within a short . . .