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Ventricular tachycardia ablation in implantable cardioverter-defibrillator recipients: a need to catch up with current recommendations.

This editorial refers to ‘Current practice of ventricular tachycardia ablation in patients with implantable cardioverter-defibrillators’ by N. Dagres et al. , Europace 2012;14(1):135–137.

Patients with structural heart disease are at risk of ventricular tachycardia (VT), a major cause of sudden cardiac death. The lifesaving benefit achieved with implantable cardioverter-defibrillators (ICD) and cardiac resyncronization therapy-defibrillation (CRT-D) devices has resulted in the increasing number of ICD/CRT-D implants. Despite an upward trend, there is still underutilization in relation to current guidelines that may be partly related to lack of centres and trained electrophysiologists. Although the exact number of active devices in Europe is unknown, it is assumed that currently there are ≥400 000 patients with ICD/CRT-D based on implantation rates and an estimated annual mortality rate of 6%.1 However, ICDs do not prevent VT and in patients in whom an ICD has been implanted for primary prevention, a first episode of VT or ventricular fibrillation (VF) occurs in 35% within 3 years with a 55% risk of subsequent device therapies;2 if the device has been implanted for secondary prevention after one episode of VT/VF, 33–69% of patients receive at least one appropriate ICD therapy within 2 years.3,4

Of importance, monomorphic VT accounts for 83–93% of all device-treated episodes.2,5,6 Although adjustment of arrhythmia detection and anti-tachycardia pacing can reduce the proportion of VTs treated with shocks, up to 21% of all monomorphic VT in 10–13% patients still necessitates shocks5,6 which have an important impact on quality of life. In addition, in patients with heart failure two or more than two appropriate shocks were associated with an eight-fold increased risk of death.7 Antitachycardia pacing can be accompanied by (pre-)syncope and followed by a shock if pacing fails; the occurrence of a single …