Catheter ablation of incessant ventricular tachycardia

Emergency catheter ablation of ventricular tachycardia was performed in 22 patients. All patients had incessant ventricular tachycardia that persisted for greater than or equal to 12 h/day and was only transiently terminated by stimulation techniques, anti-arrhythmic drugs or cardioversion. Radiofrequency catheter ablation was carried out using entrainment criteria as well as endocardial activation mapping. Ventricular tachycardia was terminated in 91% of cases, one patient underwent map-guided surgery and the remaining patient was managed by anti-arrhythmic drugs. After the initial ablation procedure 3 of the 20 patients who could be acutely managed died in hospital: one patient in refractory heart failure 24 h following ablation, one patient suddenly 10 days following ablation on the ward and another patient 4 weeks following ablation because of septicemia, Four patients underwent elective implantation of a cardioverter-defibrillator because of inducible ventricular tachycardia, and another patient underwent elective map-guided surgery. Overall, 12 patients were discharged without any additional non-pharmacologic intervention; 5 of them were: free of anti-arrhythmic drugs and 7 patients had previously received ineffective medication including continuation of amiodarone in 3 patients, These results indicate that radiofrequency catheter ablation may play a role in the treatment of patients with incessant ventricular tachycardia, Thus, non-pharmacologic management of incessant ventricular tachycardia is associated with a high hospital mortality rate especially in surgically treated patients. Catheter ablation using radiofrequency current is the preferred approach for acute palliation.