Catheter Ablation of Ventricular Tachycardia

Effectiveness of catheter ablation of ventricular tachycardia in elderly patients with structural heart disease

INTRODUCTION AND OBJECTIVES

The implantable cardioverter-defibrillator (ICD) is a well-recognized means of providing effective treatment for patients with ventricular tachycardia (VT) and structural heart disease. However, the benefits of these devices in patients with limited life-expectancy have been questioned. Moreover, the long-term efficacy of catheter ablation of VT in this setting is unknown.

METHODS

This study involved 33 consecutive patients aged over 75 years with structural heart disease who underwent catheter ablation of VT. We investigated the efficacy of the procedure and its complications, and evaluated patient outcomes during follow-up.

RESULTS

The patients' mean age at the time of the procedure was 79.7 (3.7) years. Twenty-seven had ischemic heart disease and 6 had dilated cardiomyopathy. Their mean left ventricular ejection fraction (LVEF) was 35.9 (8.9%). Ablation of clinical VT was successful in 28 patients (84.8%). There were no statistically significant differences in the efficacy of ablation between patients with post-infarction scars (88.9%) and those with dilated cardiomyopathy (66.7%; P=.17). An ICD was implanted after the procedure in 4 patients. Complications associated with the procedure occurred in only 3 patients. Twenty patients were contacted later, after a mean follow-up period of 38.5 (27.7) months. Nine (mean age, 82.2 [4.6] years) were still alive and reported a good quality of life, without recurrent arrhythmias.

CONCLUSIONS

Catheter ablation of VT in elderly patients with structural heart disease appeared to be effective and relatively safe. It could provide an alternative to ICD implantation in this patient group.