Role of interventional therapy in patients with coronary heart disease and life-threatening ventricular tachyarrhythmias.

Abstract

This study includes 357 patients with coronary heart disease and life-threatening ventricular tachyarrhythmias. Thirty-three patients (10%) underwent direct current (DC) catheter ablation (group 1), 121 (34%) mapping-guided surgery (group 2) and 203 (56%) received an implantable cardioverter defibrillator (ICD) (group 3). The mean follow-up was 35 +/- 25 months in group 1, 41 +/- 37 months in group 2 and 22 +/- 22 months in group 3. During follow-up, 6 patients (18%) died in group 1, 45 (37%) in group 2 and 46 (23%) in group 3. Sudden death occurred in two patients (6%) in group 1, 10 patients (8%) in group 2 and eight patients (4%) in group 3. Non-fatal recurrences group were observed in 19 patients (57%) in group 1 and in 16 patients (14%) in group 2. ICD discharges occurred in 175/203 patients (86%) in group 3 with a mean number of 18 +/- 28 ICD shocks per patient. Our data show that catheter ablation has a low incidence of sudden death but a high incidence of non-fatal recurrences. Mapping-guided surgery yields low rates of sudden death or recurrence. Patients with an ICD have a low sudden death rate. A treatment algorithm is necessary to evaluate patients at high risk for sudden death and to choose the right patient for the right treatment.