Early and long-term results of catheter ablation in patients with incessant ventricular tachycardia

[Short history of the DC-Catheter-Ablation]

Direct current (DC) catheter ablation in 5 patients aiming to interrupt rapid atrioventricular (AV) conduction with atrial fibrillation and subsequent pacemaker implantation was first published by M. M. Scheinman et al. (San Francisco, CA, USA) in 1982. In Germany, L. Seipel, G. Breithardt, and M. Borggrefe reported their first experience with DC catheter ablation in 1984, followed by the group in Bonn (M. Manz and B. Lüderitz) in 1985. The first international DC catheter ablation registry, which also included four German centers, reported DC catheter ablation results of 127 patients in 24 centers in 1984. Complete AV block was achieved in 71% patients. In 1992, the Hannover group (H‑J. Trappe, H. Klein and J. Huang) reported results of DC catheter ablation of AV conduction performed between 1983 and 1990 in 100 patients (86% with rapid atrial fibrillation, 14% with AV-node reentry tachycardias). The first successful DC catheter ablation in a patient with Wolff-Parkinson-White (WPW) syndrome was reported in 1985 by F. Morady et al. (San Francisco, CA, USA). In 1987, M. Borggrefe et al. were the first to report a switch from DC catheter ablation to a high-frequency (HF) catheter ablation procedure in a patient with WPW syndrome. The use of DC catheter ablation to treat ventricular tachycardia (VT) was described by G. O. Hartzler (Kansas City, MO, USA) in 3 patients in 1983. M. Borggrefe et al. (1989) reported on 24 patients who underwent DC catheter ablation for VT. Of those, 17 patients did not have VT recurrence within the following 14 months. In 1994, the Hannover group (H-J Trappe, H. Klein) published their 5‑year long-term results of DC catheter ablation of VT in 51 patients. VT recurrence occurred in 57% patients and overall mortality was also high (16%). A comparison of DC catheter ablation with HF catheter ablation for recurrent VT was reported in 1994 by G. Gonska et al. (Göttingen, Germany). After 2 years follow-up, success rates were not found to be significantly different.

Nonpharmacological therapy of ventricular tachyarrhythmias: observations in 554 patients

It has been shown that conventional antiarrhythmic drug treatment is debatable, and there is growing interest in nonpharmacological techniques. We studied the outcome of 554 patients with ventricular tachycardia (VT) or ventricular fibrillation (VF) who underwent nonpharmacological techniques from March 1980 to June 1994 at our institution. Catheter ablation was performed in 51 patients (G1), map guided surgery in 147 (G2), and cardioverter defibrillator implantation (ICD) in 356 (G3). During a mean follow-up of 37 +/- 12 (< 1-137) months, incidence of sudden death (G1 4%, G2 6%, G3 3%) and cardiac death (G1 7%, G2 16%, G3 8%) were relatively low, and there was no significant differences between G1-G3. VT/VF recurrences occurred more frequently in G1 (57%) than in G2 (18%) (P < 0.01). ICD discharges occurred in 69% of patients. We conclude that nonpharmacological techniques lead to low sudden death rates; however, there is a high rate of recurrence in G1. Risk stratification is necessary to select the ideal therapy for each individual patient.