Requirements of non-pharmacologic interventions in the treatment of recurrent sustained ventricular tachycardia

Sixty-five patients (pts) with sustained ventricular tachycardia (VT) and 1 patient with symptomatic nonsustained VT were included in this study. Of these, 5 had died before electrophysiologic study (EPS) or determination of effective antiarrhythmic drugs. Inducibility of VT by our protocol varied from 69 to 100% according to underlying diseases. Drug efficacy was evaluated by using conventional drugs in all and using flecainide and amiodarone in some. However, more than 50% of pts with inducible VT were found to be resistant to pharmacological therapy. Fourteen of 26 pts with drug-refractory VT, underwent surgical therapy. In all pts, the site of VT origin was determined and VT was either eradicated or clinically controlled in 86% of the patients. Catheter ablation was tried in 9 pts at the earliest activation site of VT or at the site where pace-mapping produced the best result in configuration in the QRS complex as the clinical VT. Prophylactic effect was confirmed in 60% but VT recurred in 3 pts. These VT became responsive to anti-arrhythmic drugs in 2 pts. In thirteen pts who died suddenly during the follow up period, none had adequate antiarrhythmic drugs. One patient died after operation because of residual VT among four different QRS morphologies found preoperatively. In conclusion, the success rate antiarrhythmic drug prophylaxis against VT induction or recurrence did not exceed 50%, therefore non-pharmacological interventions such as surgery or catheter ablation may be required.