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Catheter Ablation Prior to ICD Implantation Found Beneficial

Procedure reduces risk of ventricular tachycardia and ventricular fibrillation recurrences

MONDAY, Jan. 4 (HealthDay News) -- In patients with stable ventricular tachycardia, catheter ablation prior to implantable cardioverter defibrillator (ICD) implantation may significantly reduce the risk of ventricular tachycardia and ventricular fibrillation recurrences, according to a study in the Jan. 2 issue of The Lancet.

Karl-Heinz Kuck, M.D., of the Asklepios Klinik St Georg in Hamburg, Germany, and colleagues from the Ventricular Tachycardia Ablation in Coronary Heart Disease (VTACH) trial randomly assigned 110 patients aged 18 to 80 years who had stable ventricular tachycardia, previous myocardial infarction and reduced left-ventricular ejection fraction to ablation plus ICD or ICD only. They included 107 of the patients in the study.

After a mean follow-up of 22.5 months, the researchers found that the median time to recurrence of ventricular tachycardia or ventricular fibrillation was significantly longer in the ablation group than in the ICD-only group (19 versus six months). After two years, they also found that the estimated rate of survival free from ventricular tachycardia and ventricular fibrillation was significantly higher in the ablation group (47 versus 29 percent).

"The VTACH trial suggests that ablation be considered early, in selected patients who are receiving an implantable cardioverter defibrillator for stable ventricular tachycardia, in whom recurrences of a ventricular tachycardia are likely," state the authors of an accompanying commentary. "Evidence of a positive effect on survival, subsequent hospital admissions, or quality of life is needed before this strategy can be recommended for routine use."

Several authors reported financial relationships with device manufacturers and pharmaceutical companies, as well as with St. Jude Medical, which provided funding for the study.

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