Journal of Interventional Cardiac Electrophysiology

, Volume 25, Issue 3, pp 229–234 | Cite as

Ventricular tachycardia inducibility after radiofrequency ablation affects the outcomes in patients with coronary artery disease and implantable cardioverter-defibrillators: The role of left ventricular function

  • Andrea Colella
  • Marzia Giaccardi
  • Raffaele Molino Lova
  • Carmine Liccardi
  • Gian Franco Gensini



We hypothesized that inducibility of the VT responsible for ICD therapies at the end of RFCA, would also be associated with a differential risk, depending on left ventricular function.


We retrospectively studied 66 patients with previous myocardial infarction and with ICD who also underwent RFCA for recurrent refractory VTs.


During the follow-up only 19 patients (29%) showed VTs. Among patients with ejection fraction (EF) ≤ 35%, 11 out of 25 still continued to have VT recurrences, independent of the inducibility of the VT. Among patients with EF >35% and <50%, no recurrent VT was any longer detected in the nine patients in whom the VT was not inducible, while VT recurrences still continued only in the eight patients in whom it was. Finally, all the 24 patients with EF ≥50% did not show any recurrent VT.


Our findings confirm the role of RFCA in reducing ICD therapies and also place RFCA in the overall clinical management of recurrent post infarction VTs according to the left ventricular function.


Sudden death Ventricular tachycardia Implantable defibrillators Catheter ablation Ejection fraction 


  1. 1.
    Zipes, D. P., Camm, A. J., Borggrefe, M., Buxton, A. E., Chaitman, B., Fromer, M., et al. (2006). ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American college of cardiology/American heart association task force and the European society of cardiology committee for practice guidelines (Writing committee to develop guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death): developed in collaboration with the European heart rhythm association and the heart rhythm society. Circulation, 114(10), e385–e484.PubMedCrossRefGoogle Scholar
  2. 2.
    Huikuri, H. V., Castellanos, A., & Myerburg, R. J. (2001). Sudden death due to cardiac arrhythmias. The New England Journal of Medicine, 345, 1473–1482.PubMedCrossRefGoogle Scholar
  3. 3.
    Buxton, A. E. (2005). Identifying the high risk patient with coronary artery disease—Is ejection fraction all you need? Journal of Cardiovascular Electrophysiology, 16, S25–S27.PubMedCrossRefGoogle Scholar
  4. 4.
    DiMarco, J. P. (2003). Implantable cardioverter-defibrillators. The New England Journal of Medicine, 349, 1836–1847.PubMedCrossRefGoogle Scholar
  5. 5.
    Goldberger, Z., & Lampert, R. (2006). Implantable cardioverter-defibrillators: expanding indications and technologies. Journal of the American Medical Association, 295, 809–818.PubMedCrossRefGoogle Scholar
  6. 6.
    Bilge, A. K., Ozben, B., Demircan, S., Cinar, M., Yilmaz, E., & Adalet, K. (2006). Depression and anxiety status of patients with implantable cardioverter defibrillator and precipitating factors. Pacing and Clinical Electrophysiology, 29, 619–626.PubMedCrossRefGoogle Scholar
  7. 7.
    Pedersen, S. S., van Domburg, R. T., Theuns, D. A., Jordaens, L., & Erdeman, R. A. (2005). Concerns about the implantable cardioverter defibrillator: a determinant of anxiety and depressive symptoms independent of experienced shocks. American Heart Journal, 149, 664–669.PubMedCrossRefGoogle Scholar
  8. 8.
    Lampert, R., Joska, T., Burg, M. M., Batsford, W. P., McPherson, C. A., & Jain, D. (2002). Emotional and physical precipitants of ventricular arrhythmia. Circulation, 106, 1800–1805.PubMedCrossRefGoogle Scholar
  9. 9.
    Villacastín, J., Almendral, J., Arenal, A., Albertos, J., Ormaetxe, J., Peinado, R., et al. (1996). Incidence and clinical significance of multiple consecutive, appropriate, high energy discharges in patients with implanted cardioverter defibrillators. Circulation, 93, 753–762.PubMedGoogle Scholar
  10. 10.
    Credner, S. C., Klingenheben, T., Mauss, O., Sticherlinq, C., & Hohnloser, S. H. (1998). Electrical storm in patients with transvenous implantable cardioverter-defibrillators: incidence, management and prognostic implications. Journal of the American College of Cardiology, 32, 1909–1915.PubMedCrossRefGoogle Scholar
  11. 11.
    Sears Jr, S. E., & Conti, J. B. (2003). Understanding implantable cardioverter defibrillator shocks and storms: medical and psychosocial considerations for research and clinical care. Clinical Cardiology, 26, 107–111.PubMedCrossRefGoogle Scholar
  12. 12.
    Kamphuis, H. C. M., de Leeuw, R. J., Derksen, R., Hauer, R. N. W., & Winnubst, J. A. M. (2003). Implantable cardioverter defibrillator recipients: quality of life in recipients with and without ICD shock delivery: a prospective study. Europace, 5, 381–389.PubMedCrossRefGoogle Scholar
  13. 13.
    Hohnloser, S. H., Kuck, K. H., Dorian, P., Roberts, R. S., Hampton, J. R., Hatala, R., et al. (2004). DINAMIT Investigators. Prophylactic use of an implantable cardioverter-defibrillator after acute myocardial infarction. The New England Journal of Medicine, 351, 2481–2488.PubMedCrossRefGoogle Scholar
  14. 14.
    Moss, A. J., Greenberg, H., Case, R. B., Zareba, W., Hall, W. J., Brown, M. W., et al. (2004). Multicenter Automatic Defibrillator Implantation Trial-II Research Group. Long-term clinical course of patients after termination of ventricular tachyarrhythmia by an implanted defibrillator. Circulation, 110, 3760–3765.PubMedCrossRefGoogle Scholar
  15. 15.
    Anderson, K. P. (2005). Sudden cardiac death unresponsive to implantable defibrillator therapy: an urgent target for clinicians, industry and government. Journal of Interventional Cardiac Electrophysiology, 14, 71–78.PubMedCrossRefGoogle Scholar
  16. 16.
    Morady, F. (1999). Radiofrequency ablation as treatment for cardiac arrhythmias. The New England Journal of Medicine, 340, 534–544.PubMedCrossRefGoogle Scholar
  17. 17.
    Marchlinski, F. E., Callans, D. J., Gottlieb, C. D., & Zado, E. (2000). Linear ablation lesions for control of unmappable ventricular tachycardia in patients with ischemic and nonischemic cardiomyopathy. Circulation, 101, 1288–1296.PubMedGoogle Scholar
  18. 18.
    Reddy, V. Y., Neuzil, P., Taborsky, M., & Ruskin, J. N. (2003). Short-term results of substrate mapping and radiofrequency ablation of ischemic ventricular tachycardia using a saline-irrigated catheter. Journal of the American College of Cardiology, 41, 2228–2236.PubMedCrossRefGoogle Scholar
  19. 19.
    Calkins, H. (2005). Further insights into appropriate target sites and outcomes of catheter ablation of ventricular tachycardia in post-infarction patients. Journal of Cardiovascular Electrophysiology, 16, 472–473.PubMedCrossRefGoogle Scholar
  20. 20.
    Reddy, V. Y., Reynolds, M. R., Neuzil, P., Richardson, A. W., Taborsky, M., Jongnarangsin, K., et al. (2007). Prophylactic catheter ablation for the prevention of defibrillator therapy. The New England Journal of Medicine, 357, 2657–2665.PubMedCrossRefGoogle Scholar
  21. 21.
    Bänsch, D., Castrucci, M., Böcker, D., Breithard, G., & Block, M. (2000). Ventricular tachycardias above the initially programmed tachycardia detection interval in patients with implantable cardioverter defibrillators. Incidence, prediction and significance. Journal of the American College of Cardiology, 36, 557–565.PubMedCrossRefGoogle Scholar
  22. 22.
    Gepstein, L., Hayam, G., & Ben-Haim, S. A. (1997). A novel method for nonfluoroscopic catheter-based electroanatomical mapping of the heart: in vitro and in vivo accuracy results. Circulation, 95, 1611–1622.PubMedGoogle Scholar
  23. 23.
    Morady, F., Harvey, M., Kalbfleisch, S. J., et al. (1993). Radiofrequency catheter ablation of ventricular tachycardia in patients with coronary artery disease. Circulation, 87, 363–372.PubMedGoogle Scholar
  24. 24.
    Kim, Y. H., Sosa-Suarez, G., Trouton, T. G., O’Nunain, S. S., Osswald, S., McGovern, B. A., et al. (1994). Treatment of ventricular tachycardia by transcatheter radiofrequency ablation in patients with ischemic heart disease. Circulation, 89, 1094–1102.PubMedGoogle Scholar
  25. 25.
    Willems, S., Borggrefe, M., Shenasa, M., Chen, X., Hindricks, G., Haverkamp, W., et al. (1993). Radiofrequency catheter ablation of ventricular tachycardia following implantation of an automatic cardioverter defibrillator. Pacing and Clinical Electrophysiology, 16, 1684–1692.PubMedCrossRefGoogle Scholar
  26. 26.
    Pacifico, A., Hohnloser, S. H., Williams, J. H., Tao, B., Saksena, S., Henry, P. D., et al. (1999). Prevention of implantable defibrillator shock by treatment with sotalol. The New England Journal of Medicine, 340, 1855–1862.PubMedCrossRefGoogle Scholar
  27. 27.
    Mazur, A., Anderson, M. E., Bonney, S., & Roden, D. M. (2001). Pause-dependent polymorphic ventricular tachycardia during long-term treatment with dofetilide: a placebo-controlled, implantable cardioverter-defibrillator-based evaluation. Journal of the American College of Cardiology, 37, 1100–1105.PubMedCrossRefGoogle Scholar
  28. 28.
    Connolly, S. J., Dorian, P., Roberts, R. S., Gent, M., Bailin, S., Fain, E. S., et al. (2006). Comparison of β-blockers, amiodarone plus β-blockers, or sotalol for prevention of shocks from implantable cardioverter defibrillators: the OPTIC study: a randomized trial. Journal of the American Medical Association, 295, 165–171.PubMedCrossRefGoogle Scholar
  29. 29.
    Stevenson, W. G., Stevenson, L. W., Middlekauff, H. R., & Saxon, L. A. (1993). Sudden death prevention in patients with advanced ventricular dysfunction. Circulation, 88, 2953–2961.PubMedGoogle Scholar
  30. 30.
    Della Bella, P., De Ponti, R., Uriarte, J. A., Tondo, C., Klersy, C., Carbucicchio, C., et al. (2002). Catheter ablation and antiarrhythmic drugs for haemodynamically tolerated post-infarction ventricular tachycardia. Long-term outcome in relation to acute electrophysiological findings. European Heart Journal, 23, 414–424.PubMedCrossRefGoogle Scholar
  31. 31.
    Moss, A. J., Hall, W. J., Cannom, D. S., Daubert, J. P., Higgins, S. L., Klein, H., et al. (1996). Improved survival with an implanted defibrillator in patients with coronary disease al high risk for ventricular arrythmia. The New England Journal of Medicine, 335, 1933–1940.PubMedCrossRefGoogle Scholar
  32. 32.
    Buxton, A. E., Lee, K. L., Fisher, J. D., Josephson, M. E., Prystowsky, E. N., & Hafley, G. (1999). A randomized study of the prevention of sudden death in patients with coronary artery disease. The New England Journal of Medicine, 341, 1882–1890.PubMedCrossRefGoogle Scholar
  33. 33.
    Bardy, G. H., Lee, K. L., Mark, D. B., Poole, J. E., Packer, D. L., Boineau, R., et al. (2005). (SCD-HeFT) Investigators. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. The New England Journal of Medicine, 352, 225–237.PubMedCrossRefGoogle Scholar
  34. 34.
    Domanski, M. J., Saksena, S., Epstein, A. E., Hallstrom, A. P., Brodsky, M. A., Kim, S., et al. (1999). Relative effectiveness of the implantable cardioverter-defibrillator and antiarrhytmic drugs in patients with varying degrees of left ventricular dysfunction who have survived malignant ventricular arrhythmia. AVID investigators. Antiarrhytmic Versus implantable Defibrillators. Journal of the American College of Cardiology, 34, 1090–1095.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Andrea Colella
    • 1
    • 3
  • Marzia Giaccardi
    • 2
  • Raffaele Molino Lova
    • 2
  • Carmine Liccardi
    • 1
  • Gian Franco Gensini
    • 1
    • 2
  1. 1.Department Heart and VesselsUniversity of FlorenceFlorenceItaly
  2. 2.Department Cardiovascular RehabilitationDon Gnocchi FoundationFlorenceItaly
  3. 3.Laboratorio di ElettrofisiologiaAzienda Ospedaliero-Universitaria di CareggiFlorenceItaly

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