• William G Stevenson, David J Wilber, Andrea Natale, Warren M Jackman, Francis E Marchlinski, Timothy Talbert, Mario D Gonzalez, Seth J Worley, Emile G Daoud, Chun Hwang, Claudio Schuger, Thomas E Bump, Mohammad Jazayeri, Gery F Tomassoni, Harry A Kopelman, Kyoko Soejima, Hiroshi Nakagawa, and Multicenter Thermocool VT Ablation Trial Investigators.
• Cardiovascular Division, Brigham and Women's Hospital, Boston, MA 02115, USA. wstevenson@partners.org
• Circulation. 2008 Dec 16;118(25):2773-82.

BackgroundRecurrent ventricular tachycardia (VT) is an important cause of mortality and morbidity late after myocardial infarction. With frequent use of implantable cardioverter-defibrillators, these VTs are often poorly defined and not tolerated for mapping, factors previously viewed as relative contraindications to ablation. This observational multicenter study assessed the outcome of VT ablation with a saline-irrigated catheter combined with an electroanatomic mapping system.Methods And ResultsTwo hundred thirty-one patients (median LV ejection fraction, 0.25; heart failure in 62%) with recurrent episodes of monomorphic VT (median, 11 in the preceding 6 months) caused by prior myocardial infarction were enrolled. All inducible monomorphic VTs with a rate approximating or slower than any spontaneous VTs were targeted for ablation guided by electroanatomic mapping during sinus rhythm and/or VT. Patients were not excluded for multiple VTs (median, 3 per patient) or unmappable VT (present in 69% of patients). Ablation abolished all inducible VTs in 49% of patients. The primary end point of freedom from recurrent incessant VT or intermittent VT after 6 months of follow-up was achieved for 123 patients (53%). In 142 patients with implantable cardioverter-defibrillators before and after ablation for intermittent VT who survived 6 months, VT episodes were reduced from a median of 11.5 to 0 (P<0.0001). The 1-year mortality rate was 18%, with 72.5% of deaths attributed to ventricular arrhythmias or heart failure. The procedure mortality rate was 3%, with no strokes.ConclusionsCatheter ablation is a reasonable option to reduce episodes of recurrent VT in patients with prior myocardial infarction, even when multiple and/or unmappable VTs are present. This population remains at high risk for death, warranting surveillance and further study.

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