Catheterablation of ventricular tachycardia following myocardial infarction

Recurrent ventricular tachycardia in the setting of remote myocardial infarction are frequently resistant to antiarrhythmic drug treatment. Endocardial mapping and ablation is feasable in case of hemodynamically tolerable and reproducibly inducible forms. Identification of critical components of the reentrant circuit is mainly guided by entrainment mapping and the analysis of the post-pacing intervall. The emergence of multiple types of ventricular tachycardia is a common Limitation of the procedure. Ventricular tachycardia can be acutely abolished by radiofrequency current ablation in 60-70 % of cases when only single forms are present. This success rate is substantially lower in case of multiple tachycardia morphologies. The incidence of tachycardia recurrences varies from 20-30 %. The overall mortality during follow-up is increased due to progressive heart failure and the occurence of rapid ventricular tachyarrhythmias. Catheter ablation has been shown to be a useful tool for the treatment of clusters of ventricular tachycardia following implantation of a cardioverter-defibrillator. Furthermore, this method can be lifesaving in the setting of incessant forms. Currently, catheter ablation represents an adjunctive treatment to antiarrhythmic drugs and the implantation of a cardioverter-defibrillator. Improvement of mapping and ablation technologies may help to further increase the efficacy of this treatment strategy in the near future.