Herz
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The implantable cardioverter defibrillator (ICD) has emerged as an accepted therapy for prevention of sudden cardiac death due to ventricular arrhythmias in selected groups of high-risk patients, however, it cannot prevent the ventricular arrhythmias. ICD shocks are painful, reduce the quality of life, and spontaneous episodes of ventricular tachycardia (VT) despite effective treatment by the ICD are associated with increased mortality. ⋯ Successful catheter ablation in these patients prevents or reduces the number of VT recurrences (and ICD shocks) which will improve the quality of life and probably the long-term mortality. This review summarizes the results of recent important clinical studies in the field of catheter ablation of ventricular arrhythmias in patients with structural heart disease and ICD.
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Clinical Trial
Percutaneous cardiopulmonary support for catheter ablation of unstable ventricular arrhythmias in high-risk patients.
In patients with severe cardiomyopathy, recurrent episodes of nontolerated ventricular tachycardia (VT) or electrical storm (ES) frequently cause acute heart failure and cardiac death; the suppression of the arrhythmia is therefore lifesaving, but feasibility of catheter ablation (CA) is precluded by the adverse hemodynamic conditions together with the characteristics of the arrhythmia that interdicts efficacious mapping. The use of the percutaneous cardiopulmonary support (CPS) for circulatory assistance may allow patient's stabilization and enhance efficacy and safety of CA in this emergency setting. ⋯ The CPS warrants acceptable hemodynamic stabilization and efficacious mapping in high-risk patients undergoing CA for unstable VT in the emergency setting. Safety and efficacy of this technique translate into significant clinical improvement in the majority of patients. Even if only relatively invasive, CPS should be reserved to patients with ES or intractable arrhythmia causing acute heart failure; moreover, the need for an experienced team of multidisciplinary operators implies that its use is restricted to selected high-competency institutions.