Nonpharmacologic Therapy for Malignant Ventricular Tachyarrhythmias in Patients with Congestive Heart Failure

  • S. Saksena
Conference paper


Malignant ventricular tachyarrhythmias constitute an important cause of sudden cardiac death in patients with congestive heart failure [25]. It is increasingly recognized that despite effective treatment of congestive heart failure, life-threatening ventricular tachyarrhythmias may abbreviate patient survial. The frequency of this complication impacts significantly on the overall clinical outcome of these patients. In some instances, the therapeutic agent chosen for the treatment of congestive heart failure, for example, certain inotropic agents, may actually aggravate the ventricular tachyarrhythmia [23]. Surgical therapy in patients with congestive heart failure is also not immune to this complication. It is well-established that patients who have undergone aortic valve replacement for severe aortic valvular stenosis may experience postoperative sudden cardiac death. Clinical studies have suggested an association with the presence of complex ventricular tachyarrhythmias and nonsustained ventricular tachycardia (VT) on Holter monitoring. Similarly, patients who have undergone visually guided resection of a ventricular aneurysm or non-map-guided surgical resection of ventricular myocardium have a higher risk of recurrent postoperative ventricular tachyarrhythmias than patients who have undergone map-directed operations [40]. Finally, the presence of complex ventricular tachyarrhythmias or nonsustained VT in patients with left ventricular dysfunction due to a variety of anatomic abnormalities is an independent predictor of sudden cardiac death.


Ventricular Tachycardia Ventricular Fibrillation Catheter Ablation Ventricular Tachyarrhythmia Sustained Ventricular Tachycardia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    An H, Saksena S, Janssen M, Osypka P (1989) Radiofrequency ablation of ventricular myocardium using active fixation and passive contact catheter delivery systems. Am Heart J 118: 69PubMedCrossRefGoogle Scholar
  2. 2.
    Bach SM, Barstad J, Harper N et al. (1989) Initial clinical experience: Endotak-implantable transvenous defibrillator system. J Am Coll Cardiol 13: 65AGoogle Scholar
  3. 3.
    Borggrefe M, Budde T, Martinez-Rubio A et al. (1988) Radiofrequency catheter ablation for drug resistant supraventricular tachycardia. Circulation 78 [Suppl II]: 11–305Google Scholar
  4. 4.
    Borggrefe M, Podczeck A, Ostermeyer J et al. (1987) Long term results of electrophysiolog- ically guided tachycardia surgery in ventricular tachyarrhythmias. A collaborative report on 665 patients. In: Breithardt G, Borggrefe M, Zipes DP (eds) Non-pharmacological therapy of tachyarrhythmias. Futura, Mount Kisco, p 109Google Scholar
  5. 5.
    Branyas NA, Cain ME, Cassidy DM (1989) Transmural ventricular activation during consecutive cycles of sustained ventricular tachycardia. J Am Coll Cardiol 13: 167AGoogle Scholar
  6. 6.
    Calvo RA, Saksena S, Pantopoulos D (1988) Sequential transvenous pacing and shock therapy for termination of sustained ventricular tachycardia. Am Heart J 115: 569PubMedCrossRefGoogle Scholar
  7. 7.
    Camm AJ, Ward DE, Spurell RAJ et al. (1980) Cryothermal mapping and cryoablation in the treatment of refractory cardiac arrhythmias. Circulation 62: 67PubMedGoogle Scholar
  8. 8.
    CASS principal investigators and their associates (1983) Coronary artery surgery study (CASS): A randomized trial of coronary artery bypass surgery survival data. Circulation 68: 939CrossRefGoogle Scholar
  9. 9.
    Ciccone JM, Saksena S, Shah Y et al. (1985) A prospective, randomized study of the clinical efficacy and safety of transvenous cardioversion for ventricular tachycardia termination. Circulation 71: 571PubMedCrossRefGoogle Scholar
  10. 10.
    DePaola AAV, Horowitz LN, Morganroth J, Senior S, Spielman SR, Greenspan AM, Kay HR (1987) Influence of left ventricular dysfunction on flecainide therapy. J Am Coll Cardiol 9: 163CrossRefGoogle Scholar
  11. 11.
    Downar E, Mickleborough LL, Harris L et al. (1986) Mapping of endocardial activation during ventricular tachycardia - a “closed heart” procedure. J Am Coll Cardiol 7: 234CrossRefGoogle Scholar
  12. 12.
    ESVEM Investigators (1989) The ESVEM trial: electrophysiologic study versus electrocardiographic monitoring for selection of antiarrhythmic therapy of ventricular tachyarrhythmias. Circulation 79: 1354CrossRefGoogle Scholar
  13. 13.
    Evans GT Jr, Scheinman MM (1987) The percutaneous cardiac mapping and ablation registry: summary of results. PACE 10: 1395PubMedCrossRefGoogle Scholar
  14. 14.
    Fisher JD, Kim SG, Matos JA et al. (1983) Comparative effectiveness of pacing techniques for termination of well-tolerated sustained ventricular tachycardia. PACE 6: 915PubMedCrossRefGoogle Scholar
  15. 15.
    Follansbee WP, Michelson EL, Morganroth J (1980) Nonsustained ventricular tachycardia in ambulatory patients: characteristics and association with sudden cardiac death. Ann Intern Med 92: 741PubMedGoogle Scholar
  16. 16.
    Gallagher JJ, Svenson RH, Kasell JH et al. (1982) Catheter technique for closed chest ablation of the atrioventricular conduction system. A therapeutic alternative for the treatment of refractory supraventricular tachycardia. N Engl J Med 306: 194PubMedCrossRefGoogle Scholar
  17. 17.
    Huang SK, Bharati S, Graham AR etal. (1987) Closed chest catheter desiccation of the atrioventricular junction using radiofrequency energy - a new method of catheter ablation. J Am Coll Cardiol 9: 349PubMedCrossRefGoogle Scholar
  18. 18.
    Josephson ME, Horowitz LN, Farshid A (1978) Recurrent sustained ventricular tachycardia. 2. Endocardial mapping. Circulation 57: 440Google Scholar
  19. 19.
    Josephson ME, Harken AH, Horowitz LN (1979) Endocardial excision: a new surgical technique for the treatment of recurrent ventricular tachycardia. Circulation 60: 1430PubMedGoogle Scholar
  20. 20.
    La very S, Saksena S (1987) Management of refractory sustained ventricular tachycardia with amiodarone: a reappraisal. Am Heart J 113: 49PubMedCrossRefGoogle Scholar
  21. 21.
    Lindsay BD, Saksena S, Rothbart ST etal. (1987) Prospective evaluation of a sequential pacing and high-energy bidirectional shock algorithm for transvenous cardioversion in patients with ventricular tachycardia. Circulation 76: 601PubMedCrossRefGoogle Scholar
  22. 22.
    Miller JM, Kienzle MG, Harken AH et al. (1984) Subendocardial resection for ventricular tachycardia: predictors of surgical success. Circulation 70: 624PubMedCrossRefGoogle Scholar
  23. 23.
    Milrinone Multicenter Trial Group (1989) A comparison of oral milrinone, digoxin, and their combination in the treatment of patients with chronic heart failure. N Engl J Med 320: 677CrossRefGoogle Scholar
  24. 24.
    Mirowski M, Reid PR, Mower MM et al. (1980) Termination of malignant ventricular arrhythmias with an implanted automatic defibrillator in human beings. N Engl J Med 303: 322PubMedCrossRefGoogle Scholar
  25. 25.
    Packer M (1985) Sudden unexpected death in patients with congestive heart failure: a second frontier. Circulation 72: 681PubMedCrossRefGoogle Scholar
  26. 26.
    Saksena S (1989) Catheter ablation of tachycardias with laser energy: issues and answers. PACE 12: 196PubMedCrossRefGoogle Scholar
  27. 27.
    Saksena S, An HL (1990) Clinical efficacy of dual electrode systems for endocardial cardioversion of ventricular tachycardia: a prospective randomized crossover trial. Am Heart J 119: 15PubMedCrossRefGoogle Scholar
  28. 28.
    Saksena S, Calvo R (1985) Transvenous cardioversion and defibrillation of ventricular tachyarrhythmias: current status and future directions. PAGE 8: 715Google Scholar
  29. 29.
    Saksena S, Gadhoke A (1986) Laser therapy for tachyarrhythmias: a new frontier. PACE 9: 531PubMedCrossRefGoogle Scholar
  30. 30.
    Saksena S, Gielchinsky I (1988) Intraoperative selection of laser ablation site in patients with sustained ventricular tachycardia. PACE 11: 528Google Scholar
  31. 31.
    Saksena S, Parsonnet V (1988) Implantation of a cardioverter/defibrillator without thoracotomy using a triple electrode system. JAMA 259: 69PubMedCrossRefGoogle Scholar
  32. 32.
    Saksena S, Chandran P, Shah Y et al. (1985) Comparative efficacy of transvenous cardioversion and pacing in patients with sustained ventricular tachycardia: a prospective randomized crossover study. Circulation 72: 153PubMedCrossRefGoogle Scholar
  33. 33.
    Saksena S, Ciccone J, Chandran P et al. (1986) Laser ablation of normal and diseased human ventricle. Am Heart J 112: 52PubMedCrossRefGoogle Scholar
  34. 34.
    Saksena S, Hussain SM, Wasty N et al. (1986) Long-term efficacy of subendocardial resection in refractory ventricular tachycardia: relationship to site of arrhythmia origin. Ann Thorac Surg 42: 685PubMedCrossRefGoogle Scholar
  35. 35.
    Saksena S, Calvo RA, Pantopoulos D et al. (1987) A prospective evaluation of single and dual current pathways for transvenous cardioversion in rapid ventricular tachycardia. PACE 10: 1130PubMedCrossRefGoogle Scholar
  36. 36.
    Saksena S, Hussain SM, Gielchinsky I et al. (1987) Intraoperative mapping-guided argon laser ablation of malignant ventricular tachycardia. Am J Cardiol 59: 78PubMedCrossRefGoogle Scholar
  37. 37.
    Saksena S, Lindsay BD, Parsonnet V (1987) Development of future implantable cardioverters and defibrillators. PACE 10: 1342PubMedCrossRefGoogle Scholar
  38. 38.
    Saksena S, Pantopoulos D, Hussain SM et al. (1987) Mechanisms of ventricular tachycardia termination and acceleration during transvenous cardioversion as determined by cardiac mapping in man. Am Heart J 113: 1495PubMedCrossRefGoogle Scholar
  39. 39.
    Saksena S, Tarjan PP, Bharati S et al. (1987) Low energy transvenous ablation of the atrioventricular conduction system using a suction electrode catheter. Circulation 76: 394PubMedCrossRefGoogle Scholar
  40. 40.
    Saksena S, Hussain SM, Gielchinsky I (1988) Surgical ablation of tachyarrhythmias: reflections for the third decade (editorial). PACE 11: 103PubMedCrossRefGoogle Scholar
  41. 41.
    Saksena S, Gielchinsky I, Tullo NG (1989) Argon laser ablation of malignant ventricular tachycardia associated with coronary artery disease. Am J Cardiol 64: 1298PubMedCrossRefGoogle Scholar
  42. 42.
    Saksena S, Scott S, Accorti P et al. (1989) Improved pacing and internal defibrillation using a porous electrode catheter with biphasic unidirectional and bidirectional shocks. PACE 12 (1): 663CrossRefGoogle Scholar
  43. 43.
    Saksena S, Tullo NG, Krol RB etal. (1989) Initial clinical experience with endocardial defibrillation using an implantable cardioverter/defibrillator with a triple electrode system. Arch Intern Med 149: 2333PubMedCrossRefGoogle Scholar
  44. 44.
    Scheinman MM, Morady F, Hess DS et al. (1982) Catheter induced ablation of the atrioventricular junction to control refractory supraventricular arrhythmias. JAMA 248: 851PubMedCrossRefGoogle Scholar
  45. 45.
    Thomas A, Moser SA, Smutka ML et al. (1988) Implantable defibrillation: eight year clinical experience. PACE 11: 2053PubMedCrossRefGoogle Scholar
  46. 46.
    Tullo NG, An H, Saksena S (1989) Ablation using radiofrequency current and low energy D.C. shocks. In: Saksena S, Goldschlager N (eds) Textbook of electrical therapy for cardiac arrhythmias. Saunders, PhiladelphiaGoogle Scholar
  47. 47.
    Vedel J, Frank R, Fontaine G et al. (1979) Bloc auriculo-ventriculaire intra-Hisien définitif induit au cours d’une exploration endoventriculaire droite. Arch Mal Coeur 72: 107PubMedGoogle Scholar
  48. 48.
    Veltri EP, Reid PR, Platia EV, Griffith LSC (1985) Amiodarone in the treatment of life- threatening ventricular tachycardia: role of Holter monitoring in predicting long-term clinical efficacy. J Am Coll Cardiol 6: 806PubMedCrossRefGoogle Scholar
  49. 49.
    Warm JF, Hassaguerre M, Lemetayer P et al. (1988) Catheter ablation of accessory pathways with a direct approach. Circulation 78: 800CrossRefGoogle Scholar
  50. 50.
    Wilber DJ, Garan H, Finkelstein D et al. (1988) Out of hospital cardiac arrest: use of electrophysiologic testing in the prediction of long-term outcome. N Engl J Med 38: 19CrossRefGoogle Scholar
  51. 51.
    Zipes DP, Jackman WM, Heger JJ (1982) Clinical transvenous cardioversion of recurrent life-threatening tachyarrhythmias: low energy synchronized cardioversion of ventricular tachycardia and termination of ventricular fibrillation in patients using a catheter electrode. Am Heart J 103: 789PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1990

Authors and Affiliations

  • S. Saksena

There are no affiliations available

Personalised recommendations