Ventricular Tachycardia Ablation

ince the first electrocardiographic recordings, ventricular tachycardia (VT) has been associated with both significant morbidity and mortality.1 VT most commonly occurs in the presence of structural heart disease that produces myocardial fibrosis, such as myocardial infarction, nonischemic cardiomyopathy, sarcoidosis, and many other diseases.As such, the prognosis of a patient with VT mainly mirrors the extent of underlying heart disease.The prevalence of coronary artery disease in the US population has been shown to increase with age, reaching 20% in subjects >75 years of age. 2 Prior to implantable cardioverter defibrillators, the overall downward trajectory of patients with VT proved insurmountable (and at times accelerated) by antiarrhythmic pharmacological therapies in those with structural heart disease.3 The era of revascularization and neurohormonal blockade has seen significant improvement in long-term morbidity and mortality for patients with heart failure.4 With modern medical therapy, patients are living longer and competing risks begin to emerge.VT remains a shadow in the dark-an ever-present threat that often presents itself during significant clinical deterioration but can occur suddenly without preceding symptoms.The implantable cardioverter defibrillator in this regard may be both a blessing and a curse: a therapy that could save the patient from sudden death; however, the delivery of this therapy is often painful, can occur repeatedly, and does nothing to prevent recurrence or improve quality of life.As the population of patients with structural heart disease and implantable cardioverter defibrillators continues to age, we need to address the question of whether catheter ablation for VT is as effective in the elderly as it is for younger patients.Growing clinical trial data has added weight behind the use of catheter ablation for the management of recurrent VT.The VANISH trial (Ventricular Tachycardia Ablation Versus Escalated Antiarrhythmic Drug Therapy in Ischemic Heart Disease) 5 demonstrated that catheter ablation is an effective therapy that can improve a composite end point of death, VT storm, or implantable cardioverter defibrillator shock compared with escalation of medical therapy.Although prior randomized VT ablation trials have included patients >70 years of age, the number of patients has been relatively small with no specific reporting of outcomes in the elderly.As in all emerging therapies, the elderly are often not offered treatment early in the experience.In the Thermocool VT trial, Stevenson et al 6 reported the outcomes of 231 patients with a mean age of 67 years and median follow-up of 36 months.Della Bella et al 7 reported long-term outcome data in 528 patients with a mean age of 61 years and median follow-up of 26 months.Although there may be an assumption that elderly patients are at higher risk for complications from invasive procedures, this has not been consistently dem- Ventricular Tachycardia AblationAre We in a New Age?