[Defibrillator implantation associated with ventricular arrhythmia ablation: an emerging hybrid approach]

Ventricular arrhythmias are an important cause of morbidity and mortality and are the leading cause of sudden cardiac death. Although implantable cardioverter-defibrillators (ICD) proved to be effective in reducing both sudden cardiac death and all-cause mortality, the ideal therapy remains to be defined because ICD implantation allows to interrupt life-threatening ventricular arrhythmias but does not prevent them. ICD interventions, in terms of shock delivery and antitachycardia pacing, are often associated with invalidating symptoms, such as chest pain, sensation of rapid heartbeat and syncope, and may cause depression in many patients. Both appropriate and inappropriate shocks have been shown to be associated with a worse prognosis. Transcatheter ablation proved to be safe and effective in reducing arrhythmia relapse in patients who experience multiple ICD interventions or electrical storm. In the latter patient subset, ablation often represents the only possibility of interrupting such dramatic events. Ablation has also been evaluated in patients implanted with an ICD in secondary prevention, before device intervention. To date, transcatheter ablation represents an optimal opportunity, complementary to ICD, in the treatment of patients at high risk for sudden death and episodes of ventricular arrhythmias.