Role of interventional therapy in patients with coronary heart disease and life-threatening ventricular tachyarrhythmias.
This study includes 357 patients with coronary heart disease and life-threatening ventricular tachyarrhythmias. Thirty-three patients (10%) underwent direct current (DC) catheter ablation (group 1), 121 (34%) mapping-guided surgery (group 2) and 203 (56%) received an implantable cardioverter defibrillator (ICD) (group 3). The mean follow-up was 35 +/- 25 months in group 1, 41 +/- 37 months in group 2 and 22 +/- 22 months in group 3. During follow-up, 6 patients (18%) died in group 1, 45 (37%) in group 2 and 46 (23%) in group 3. Sudden death occurred in two patients (6%) in group 1, 10 patients (8%) in group 2 and eight patients (4%) in group 3. Non-fatal recurrences group were observed in 19 patients (57%) in group 1 and in 16 patients (14%) in group 2. ICD discharges occurred in 175/203 patients (86%) in group 3 with a mean number of 18 +/- 28 ICD shocks per patient. Our data show that catheter ablation has a low incidence of sudden death but a high incidence of non-fatal recurrences. Mapping-guided surgery yields low rates of sudden death or recurrence. Patients with an ICD have a low sudden death rate. A treatment algorithm is necessary to evaluate patients at high risk for sudden death and to choose the right patient for the right treatment.
Trappe
H J
HJ
Department of Cardiology, University Hospital Hannover, Germany.
Klein
H
H
Wenzlaff
P
P
Fieguth
H G
HG
Wahlers
T
T
Kielblock
B
B
Lichtlen
P R
PR
D000293:Adolescent; D000328:Adult; D000368:Aged; D017115:Catheter Ablation; D003327:Coronary Disease / Q000150:complications*; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D017147:Defibrillators, Implantable; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D015996:Survival Rate; D017180:Tachycardia, Ventricular / Q000209:etiology / Q000401:mortality / Q000601:surgery / Q000628:therapy*