Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Sep 2013
Review[Indications for catheter ablation of ventricular tachycardia].
Ventricular tachyarrhythmias (VT) can cause sudden cardiac death. This can be prevented by an implantable cardioverter-defibrillator (ICD) but approximately 25% of patients with an ICD develop electrical storm (≥ 3 VTs within 24 hours) during the course of 4-5 years. This is a life-threatening event even in the presence of an ICD, particularly if incessant VT is present, and may significantly deteriorate the patient's psychological state if multiple shocks are discharged. ⋯ In patients with ischemic or non-ischemic cardiomyopathy, VT ablation is complementary to ICD implantation and can reduce the number of ventricular arrhythmia episodes and shocks and should be performed early. In patients with electrical storm, catheter ablation can acutely achieve rhythm stabilization and may improve prognosis in the long term. Further indications for catheter ablation exist in patients with idiopathic VT where catheter ablation represents a curative therapy, and in patients with symptomatic or asymptomatic frequent premature ventricular beats which may improve prognosis in patients with heart failure and cardiac resynchronization therapy.
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This review will address the pathophysiology, incidence, current outcome and treatment options of patients with cardiogenic shock complicating acute myocardial infarction. The major focus will be on the current evidence based on randomized clinical trials and the current guideline recommendations for the treatment of cardiogenic shock.