Role of Electrophysiologic Study (EPS)-Guided Preventive Therapy for the Management of Ventricular Tachyarrhythmias in Patients With Heart Failure

Abstract

Background Ventricular tachyarrhythmias (VT/VF) are 1 of the most important factors determining the prognosis of patients with heart failure (HF). Although priority is given to implantable cardioverter defibrillator (ICD) therapy for the prevention of sudden cardiac death, electrophysiologic-study (EPS)-guided preventive therapy could be important for reducing the number of cardiac events. Methods and ResultsOf 864 patients with a history of HF, an EPS was performed in 168 and 121 had inducible VT/VF. Under the basic therapy of an ICD, additional catheter ablation was attempted for 95 of 124 monomorphic VT foci in 74 patients, and 78 of the VT were successfully ablated. The prognoses were compared among 5 patient groups with different results for the EPS and catheter ablation: (1) success group (n=43), (2) failure group (n=15), (3) not attempted group (n=16), (4) VF group (n=47), and (5) no inducible VT/VF group. During a follow-up period of 31±22 months, the incidence of VT/VF was lower in the success and no inducible VT/VF groups than in the other groups (p=0.0018), although a significant difference was not observed for the total deaths. Conclusion EPS-guided preventive therapy using an ICD and catheter ablation can be useful, at least for the reduction of arrhythmic events in patients with HF. (Circ J 2008; 72: 268 -273)

Meta-analysis of catheter ablation as an adjunct to medical therapy for treatment of ventricular tachycardia in patients with structural heart disease

“…Another registry and planned randomized study from Poland was excluded due to failure to enroll patients into the randomized portion of the study 18. The studies selected for final meta-analysis included 2 published randomized clinical trials,19, 20 2 randomized trials that are only available in abstract format,21, 22 and an observational study with a patient group that did not undergo ablation 23…”

“…The non-randomized study, conducted by Niwano et al, was a single center observational study conducted in Japan with five study groups: 1) acute successful ablation, 2) acute failed ablation, 3) ablation not attempted, 4) ventricular fibrillation, and 5) no inducible VT/ventricular fibrillation groups. 23 For the purposes of our analysis, the acute successful and failed ablation groups (groups 1 and 2) were combined as the arm allocated to adjunctive catheter ablation and their long-term outcomes compared with the ablation not attempted group (group 3). Both groups received medical therapy with beta-blockers.…”

Efficacy of Procainamide and Lidocaine in Terminating Sustained Monomorphic Ventricular Tachycardia - Retrospective Case Series -

“…29 Endocardial mapping may show fractionated or continuous electrograms at the site of origin of SMVT, 30 and at the critical site, some cases of SMVT can be successfully ablated. 31 Class I antiarrhythmic drugs preferentially depress the conduction within the area of slow conduction, 32-34 and procainamide is considered to result in termination by increasing the refractoriness within that area. 35,36 Caution needs to be paid to a fall in blood pressure when procainamide is given to patients with cardiac dysfunction.…”

Catheter Ablation at the Forefront: The Tribulations of Clinical Trials

“…VT RFA has consistently been shown to reduce VT recurrence and ICD shocks in the ischemic [10][11][12][13][14][15] and nonischemic population. [16][17][18] The majority of studies to date have been limited to single-center studies, registries, and small randomized trials.…”