Volume 69 Number 4 September 2002	back to contents

Ventricular Arrhythmia: Role of the Implantable Cardioverter Defibrillator and Radiofrequency Ablation in Addition to Drugs	197-207
Avi Fischer, M.D.1, Rajiv Verma, M.D.1, Joseph A. Gomes, M.D.2, and Davendra Mehta, M.D., Ph.D.3

¹Cardiology Fellow, ²Professor of Medicine, Director, Section of Electrophysiology, and ³Associate Professor of Medicine, Director, Clinical Electrophysiology Lab, The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, NY.

Address correspondence to Davendra Mehta, M.D., Ph.D., Director, Clinical Electrophysiology Lab, The Zena and Michael A. Wiener Cardiovascular Institute, Box 1030, Mount Sinai School of Medicine, New York, NY 10029.

Adapted from a Cardiology Grand Rounds presentation to the Cardiovascular Institute, Mount Sinai School of Medicine, New York, NY on November 27, 2000 and updated as of July 2001.

ABSTRACT

The control of life-threatening arrhythmias in the prevention of sudden cardiac death has been a long-standing challenge to clinicians. Large-scale, randomized, controlled trials have contributed immensely to our understanding of the management of life-threatening arrhythmias. There are many causes of life-threatening ventricular arrhythmias, which they occur mostly in the setting of healed myocardial infarction. Available treatments for the management of ventricular arrhythmias include antiarrhythmic drugs, implantable cardioverter defibrillators and catheter ablation. Each therapy provides unique advantages for selected patients with life-threatening arrhythmias. Because the goal of arrhythmia management is not only to provide the single best therapy but to provide the greatest assurance of symptomatic arrhythmia control, the use of combined therapy has become a standard treatment strategy for patients with sustained ventricular arrhythmias. This review will discuss the different modes of treatment available for the treatment of life-threatening ventricular arrhythmias, and their potential risks and benefits. The rationale for using hybrid or combination therapy will be presented. Finally, some of the better-known primary and secondary prevention trials for treatment of ventricular tachycardias will be reviewed.

KEYWORDS

Sudden cardiac death, ventricular tachycardia, antiarrhythmic agents, implantable cardioverter defibrillator, radiofrequency ablation.

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