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Canadian Journal of Cardiology

Catheter Ablation of Ventricular Tachycardia: Making a Difference, but Not Saving Lives?

Published:January 09, 2023DOI:https://doi.org/10.1016/j.cjca.2023.01.004
      The development of ventricular tachycardia (VT) in the setting of structural heart disease (SHD) is a harbinger of doom. VT carries with it the obvious risk of sudden arrhythmic death, which is largely mitigated by implantable cardioverter defibrillators (ICDs). Yet these devices do not prevent or reduce VT, and the further effects of VT have become clear in the ICD era. Recurrent ICD shocks are associated with increased subsequent mortality,
      • Poole J.E.
      • Johnson G.W.
      • Hellkamp A.S.
      • et al.
      Prognostic importance of defibrillator shocks in patients with heart failure.
      and even recurrent antitachycardia pacing is associated with increased morbidity.
      • Strickberger S.A.
      • Canby R.
      • Cooper J.
      • et al.
      Association of antitachycardia pacing or shocks with survival in 69,000 patients with an implantable defibrillator.
      Notably, the occurrence of VT dramatically increases the risk of new or decompensated heart failure.
      • Goldenberg I.
      • Moss A.J.
      • Hall W.J.
      • et al.
      Causes and consequences of heart failure after prophylactic implantation of a defibrillator in the Multicenter Automatic Defibrillator Implantation Trial II.
      Of utmost importance is the fact that recurrent ICD therapies are independently associated with a reduced quality of life, increased anxiety, and reduced mental well-being.
      • Schron E.B.
      • Exner D.V.
      • Yao Q.
      • et al.
      Quality of life in the antiarrhythmics versus implantable defibrillators trial: impact of therapy and influence of adverse symptoms and defibrillator shocks.
      ,
      • Irvine J.
      • Dorian P.
      • Baker B.
      • et al.
      Quality of life in the Canadian Implantable Defibrillator Study (CIDS).
      These significant effects form the thrust of the search for better treatment of VT in patients with SHD.
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