Key result
Catheter ablation without ICD carries low sudden death risk in structural heart disease with preserved LVEF.
Why the study?
Whether the class 1 indication for ICD in sustained monomorphic VT extends to patients with preserved left ventricular function and well-tolerated arrhythmias is poorly known.
Does catheter ablation alone prevent sudden death as effectively as ICD implantation in patients with structural heart disease, preserved LVEF, and well-tolerated sustained ventricular tachycardia?
Does catheter ablation alone prevent sudden death as effectively as ICD implantation in patients with structural heart disease, preserved LVEF, and well-tolerated sustained ventricular tachycardia?
Catheter ablation alone may be a safe alternative to ICD implantation in selected patients with structural heart disease, preserved LVEF, and well-tolerated VT, though randomized trials are urgently needed.
May support ablation alone in selected preserved-LVEF VT patients; leaves open confirmation versus ICD in randomized trials.
INTRODUCTION: The occurrence of a sustained monomorphic ventricular tachycardia in patients with structural heart disease is a class 1 indication for ICD because of the expected relevant risk of sudden death. However, if this concerns selected patients with preserved left ventricular function and well-tolerated arrhythmias is still poorly known. AREAS COVERED: In this article, we review the available data about the natural history of nonimplanted patients with structural heart disease and sustained ventricular tachycardia and the possible role of catheter ablation alone in this population. EXPERT OPINION: In structural heart disease patients with well-tolerated sustained ventricular tachycardia and preserved LVEF, catheter ablation alone, without ICD implantation, does not seem to carry an important risk of sudden death and the prognosis of these patients is mainly nonarrhythmic. Randomized prospective trials are urgently needed for evaluating the place of first choice ablation without ICD implantation in these populations.
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Maury et al. (2022) conducted a review in Structural heart disease with sustained ventricular tachycardia and preserved LVEF. Catheter ablation alone vs. Implantable cardioverter-defibrillators (ICD) was evaluated on Sudden death. Catheter ablation alone without ICD implantation in patients with structural heart disease, well-tolerated sustained VT, and preserved LVEF does not appear to carry a significant risk of sudden death.
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