Catheter ablation is now an important therapy option to be considered when trying to control recurrent ventricular tachycardias (VT). To ensure that physicians have up to date knowledge of this evolving therapy, which can be life-saving for some patients, and promote the best patient care, the European Heart Rhythm Association and the Heart Rhythm Society have prepared EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. The consensus statement was released on 14 May at Heart Rhythm 2009, the Society’s 30th Annual Scientific Sessions, in Boston, USA.
“As the field progresses, it is important that the medical profession plays a significant role in critically evaluating therapies as they are introduced and evolve,” said Dr Etienne Aliot, Hôpital de Brabois, Vandoeuvre-les-Nancy, France, and cochair of the task force. “In the past ablation was often not considered until pharmacological options had been exhausted, and often patients had suffered from recurrent episodes of VT and multiple ICD shocks. Based on available studies, experts now affirm that catheter ablation should be considered as an earlier treatment.”
The European Heart Rhythm Association and the Heart Rhythm Society created a task force of international experts to conduct rigorous analysis of the available data documenting indications, techniques, benefits and risks and outcomes to produce guidance to improve the effectiveness of care, optimise patient outcomes and identify areas for improvement and future research. The statement summarizes the opinion of the task force members based on their analysis of the literature, as well as their experience in treating patients, and is directed to all health care professionals, health care institutions, manufacturers and governmental, reimbursement and regulatory bodies who are involved in the care of patients with VTs.
The new consensus statement offers guidance on a range of issues including:
- Indications for catheter ablation of ventricular tachycardia;
- Technical aspects such as mapping systems, robotic navigation, imaging, energy sources for ablation, anticoagulation and arrhythmic drug management;
- Mechanisms of specific types of VTs;
- Ablation outcomes and considerations in specific diseases;
- Ablation approaches and outcomes for idiopathic VTs that are not due to structural heart disease;
- Training, institutional requirements and competencies for centers and physicians performing ablation;
- Clinical trial considerations and needs for future research.
“When considering catheter ablation treatment, physicians should take into account the risks and benefits that are determined by patient characteristics, as well as the availability of appropriate facilities with technical expertise,” said Dr William Stevenson, Brigham and Women’s Hospital in Boston, and co-chair of the task force. “This consensus statement defines the indications, techniques and outcomes of catheter ablation procedure specific for the treatment of VT.”
The complete guidelines will be published in the June issue of the HeartRhythm Journal, the official journal of the Heart Rhythm Society, and Europace.