title: Radio-frequency ablation as primary management of well-tolerated sustained monomorphic ventricular tachycardia in patients with structural heart disease and left ventricular ejection fraction over 30%.
abstract: OBJECTIVE
  Patients with well-tolerated sustained monomorphic ventricular tachycardia (SMVT) and left ventricular ejection fraction (LVEF) over 30% may benefit from a primary strategy of VT ablation without immediate need for a 'back-up' implantable cardioverter-defibrillator (ICD).
  
  
  RESULTS
  One hundred and sixty-six patients with structural heart disease (SHD), LVEF over 30%, and well-tolerated SMVT (no syncope) underwent primary radiofrequency ablation without ICD implantation at eight European centres. There were 139 men (84%) with mean age 62 ± 15 years and mean LVEF of 50 ± 10%. Fifty-five percent had ischaemic heart disease, 19% non-ischaemic cardiomyopathy, and 12% arrhythmogenic right ventricular cardiomyopathy. Three hundred seventy-eight similar patients were implanted with an ICD during the same period and serve as a control group. All-cause mortality was 12% (20 patients) over a mean follow-up of 32 ± 27 months. Eight patients (40%) died from non-cardiovascular causes, 8 (40%) died from non-arrhythmic cardiovascular causes, and 4 (20%) died suddenly (SD) (2.4% of the population). All-cause mortality in the control group was 12%. Twenty-seven patients (16%) had a non-fatal recurrence at a median time of 5 months, while 20 patients (12%) required an ICD, of whom 4 died (20%).
  
  
  CONCLUSIONS
  Patients with well-tolerated SMVT, SHD, and LVEF > 30% undergoing primary VT ablation without a back-up ICD had a very low rate of arrhythmic death and recurrences were generally non-fatal. These data would support a randomized clinical trial comparing this approach with others incorporating implantation of an ICD as a primary strategy.
authors.affiliation: Department of Cardiology, University Hospital Rangueil, 31059 Toulouse Cedex 09, France mauryjphil@hotmail.com.
authors.forename: Philippe
authors.initials: P
authors.lastname: Maury
authors.affiliation: Ospedale San Raffaele, Milano, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Baratto
authors.affiliation: University Hospital Leiden, Leiden, Netherlands.
authors.forename: Katja
authors.initials: K
authors.lastname: Zeppenfeld
authors.affiliation: University of Western, London, ON, Canada.
authors.forename: George
authors.initials: G
authors.lastname: Klein
authors.affiliation: University Hospital, Berne, Switzerland.
authors.forename: Etienne
authors.initials: E
authors.lastname: Delacretaz
authors.affiliation: University Hospital Haut-Leveque, Pessac, France.
authors.forename: Frederic
authors.initials: F
authors.lastname: Sacher
authors.affiliation: Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: Etienne
authors.initials: E
authors.lastname: Pruvot
authors.affiliation: University Hospital Lille, Lille, France.
authors.forename: Francois
authors.initials: F
authors.lastname: Brigadeau
authors.affiliation: Department of Cardiology, University Hospital Rangueil, 31059 Toulouse Cedex 09, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Rollin
authors.affiliation: University Hospital Nancy, Nancy, France.
authors.forename: Marius
authors.initials: M
authors.lastname: Andronache
authors.affiliation: Ospedale San Raffaele, Milano, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Maccabelli
authors.affiliation: University Hospital Leiden, Leiden, Netherlands.
authors.forename: Marcin
authors.initials: M
authors.lastname: Gawrysiak
authors.affiliation: University Hospital, Berne, Switzerland.
authors.forename: Roman
authors.initials: R
authors.lastname: Brenner
authors.affiliation: University Hospital Haut-Leveque, Pessac, France.
authors.forename: Andrei
authors.initials: A
authors.lastname: Forclaz
authors.affiliation: Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: Jürg
authors.initials: J
authors.lastname: Schlaepfer
authors.affiliation: University Hospital Lille, Lille, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Lacroix
authors.affiliation: Department of Cardiology, University Hospital Rangueil, 31059 Toulouse Cedex 09, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Duparc
authors.affiliation: Department of Cardiology, University Hospital Rangueil, 31059 Toulouse Cedex 09, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Mondoly
authors.affiliation: Department of Cardiology, University Hospital Rangueil, 31059 Toulouse Cedex 09, France.
authors.forename: Frederic
authors.initials: F
authors.lastname: Bouisset
authors.affiliation: Department of Cardiology, University Hospital Rangueil, 31059 Toulouse Cedex 09, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Delay
authors.affiliation: University Hospital Haut-Leveque, Pessac, France.
authors.forename: Meleze
authors.initials: M
authors.lastname: Hocini
authors.affiliation: University Hospital Haut-Leveque, Pessac, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Derval
authors.affiliation: University Hospital Nancy, Nancy, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Sadoul
authors.affiliation: University Hospital Nancy, Nancy, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Magnin-Poull
authors.affiliation: University Hospital Lille, Lille, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Klug
authors.affiliation: University Hospital Haut-Leveque, Pessac, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Haïssaguerre
authors.affiliation: University Hospital Haut-Leveque, Pessac, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Jaïs
authors.affiliation: Ospedale San Raffaele, Milano, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Della Bella
authors.affiliation: University Hospital Nancy, Nancy, France.
authors.forename: Christian
authors.initials: C
authors.lastname: De Chillou
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017115:Catheter Ablation / Q000379:methods* / Q000401:mortality; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control; D017147:Defibrillators, Implantable; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology; D017180:Tachycardia, Ventricular / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Ablation; Implantable cardioverter defibrillator; Radio-frequency; Sudden death; Ventricular tachycardia