title: Patients treated with catheter ablation for ventricular tachycardia after an ICD shock have lower long-term rates of death and heart failure hospitalization than do patients treated with medical management only.
abstract: BACKGROUND
  Ventricular arrhythmias in patients with implantable cardioverter-defibrillators (ICDs) adversely affect outcomes. Antiarrhythmic approaches to ventricular tachycardia (VT) have variable efficacy and may increase risk of ventricular arrhythmias, worsening cardiomyopathy, and death. Comparatively, VT ablation is an alternative approach that may favorably affect outcomes.
  
  
  OBJECTIVE
  To further explore the effect on long-term outcomes after catheter ablation of VT, we compared patients with history of ICD shocks who did not undergo ablation, patients with a history of ICD shocks that underwent ablation, and patients with ICDs who had no history of ICD shocks.
  
  
  METHODS
  A total of 102 consecutive patients with structural heart disease who underwent VT ablation for recurrent ICD shocks were compared with 2088 patients with ICDs and no history of appropriate shocks and 817 patients with ICDs and a history of appropriate shocks for VT or ventricular fibrillation. Outcomes considered were mortality, heart failure hospitalization, atrial fibrillation, and stroke/transient ischemic attack.
  
  
  RESULTS
  The mean age of 3007 patients was 65.4 ± 13.9 years. Over long-term follow-up, 866 (28.8%) died, 681 (22.7%) had a heart failure admission, 706 (23.5%) developed new-onset atrial fibrillation, and 224 (7.5%) had a stroke. The multivariate-adjusted risks of deaths and heart failure hospitalizations were higher in patients with history of ICD shocks who were treated medically than in patients with ICDs and no history of shock (hazard ratio [HR] 1.45; P < .0001 vs HR 2.00; P < .0001, respectively). The multivariate-adjusted risks were attenuated after VT ablation with death and heart failure hospitalization rates similar to those of patients with no shock (HR 0.89; P = .58 vs HR 1.38; P = .09, respectively). A similar nonsignificant trend was seen with stroke/transient ischemic attack.
  
  
  CONCLUSIONS
  Patients treated with VT ablation after an ICD shock have a significantly lower risk of death and heart failure hospitalization than did patients managed medically only. The adverse event rates after VT ablation were similar to those of patients with ICDs but without VT.
authors: Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah. Electronic address: Thomas.bunch@imail.org.
authors: T Jared
authors: TJ
authors: Bunch
authors: Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah.
authors: J Peter
authors: JP
authors: Weiss
authors: Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah.
authors: Brian G
authors: BG
authors: Crandall
authors: Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah.
authors: John D
authors: JD
authors: Day
authors: Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah.
authors: Heidi T
authors: HT
authors: May
authors: Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah.
authors: Tami L
authors: TL
authors: Bair
authors: Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah.
authors: Jeffrey S
authors: JS
authors: Osborn
authors: Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah.
authors: Charles
authors: C
authors: Mallender
authors: St Jude Medical Corporation, St. Paul, Minnesota.
authors: Avi
authors: A
authors: Fischer
authors: St Jude Medical Corporation, St. Paul, Minnesota.
authors: Kyle J
authors: KJ
authors: Brunner
authors: St Jude Medical Corporation, St. Paul, Minnesota.
authors: Srijoy
authors: S
authors: Mahapatra
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000209:etiology; D017115:Catheter Ablation / Q000009:adverse effects; D017147:Defibrillators, Implantable; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000209:etiology / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D017180:Tachycardia, Ventricular / Q000628:therapy*; D016896:Treatment Outcome
keywords: Atrial fibrillation; Catheter ablation; Heart failure; Mortality; Ventricular tachycardia