title: Prophylactic catheter ablation for induced monomorphic ventricular tachycardia in patients with implantable cardioverter defibrillators as primary prevention.
abstract: OBJECTIVE
  Prophylactic catheter ablation (CA) has been established to reduce the incidence of appropriate implantable cardioverter-defibrillator (ICD) therapy (anti-tachycardia pacing or shock) in secondary prevention patients. The aim of this study was to determine whether prophylactic CA for induced ventricular tachycardia (VT) reduces the incidence of appropriate ICD therapy in primary prevention patients.
  
  
  RESULTS
  We retrospectively investigated 66 consecutive patients with structural heart disease who had undergone ICD implantation as primary prevention and electrophysiological study. Patients with hypertrophic cardiomyopathy or no inducible monomorphic VT had been excluded, and the remaining 38 patients were divided into two groups; those who had undergone prophylactic CA for induced monomorphic VT (the CA group, n = 18), and those who had not undergone CA (the non-CA group, n = 20). During a mean follow-up of 50 ± 38 months, 1 patient (5%) received appropriate ICD therapy in the CA group and 13 (65%) in the non-CA group. Kaplan-Meier survival analysis revealed a significantly higher event-free survival rates for appropriate ICD therapy in the CA group compared with the non-CA group (P = 0.003). Among the patients, one patient (5%) in the CA group and nine patients (45%) in the non-CA group suffered appropriate shock (P = 0.018).
  
  
  CONCLUSIONS
  Prophylactic CA for induced monomorphic VT reduces the incidence of appropriate ICD therapy including shock in primary prevention patients. These results indicate that prophylactic CA may be considered for structural heart disease patients who are candidates for ICD implantation as primary prevention.
authors.affiliation: Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya-ku, Tokyo 150-0013, Japan.
authors.forename: Takekuni
authors.initials: T
authors.lastname: Hayashi
authors.forename: Seiji
authors.initials: S
authors.lastname: Fukamizu
authors.forename: Rintaro
authors.initials: R
authors.lastname: Hojo
authors.forename: Kota
authors.initials: K
authors.lastname: Komiyama
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Tanabe
authors.forename: Tamotsu
authors.initials: T
authors.lastname: Tejima
authors.forename: Kyoko
authors.initials: K
authors.lastname: Soejima
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Nishizaki
authors.forename: Masayasu
authors.initials: M
authors.lastname: Hiraoka
authors.forename: Junya
authors.initials: J
authors.lastname: Ako
authors.forename: Shin-Ichi
authors.initials: S
authors.lastname: Momomura
authors.forename: Harumizu
authors.initials: H
authors.lastname: Sakurada
mesh_terms: D000368:Aged; D009202:Cardiomyopathies / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D017115:Catheter Ablation; D016009:Chi-Square Distribution; D017147:Defibrillators, Implantable; D018572:Disease-Free Survival; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011322:Primary Prevention / Q000295:instrumentation* / Q000379:methods; D012189:Retrospective Studies; D013318:Stroke Volume; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
keywords: Catheter ablation; Implantable cardioverter-defibrillator; Primary prevention; Ventricular tachycardia