LAUSR

SEE PAGE 3070 I mplantable cardioverter-defibrillators (ICDs) have been proven to prolong life in patients with cardiomyopathy and reduced ejection fraction; however, the major morbidity associated with ICDs has been recurrent ICD shocks for ventricular tachycardia or ventricular fibrillation (VT/VF). Treatment for VT/VF typically involves suppression with antiarrhythmic drugs, catheter ablation, or both. Catheter ablation has made tremendous strides in the past 2 decades because of improvements in substrate modification techniques for poorly tolerated VT, hemodynamic support in patients with severely depressed ejection fraction, epicardial ablation approaches, surgical ablation, and more advanced mapping and ablation technologies. Yet recurrence rates after VT ablation in several prospective studies still approach and sometimes exceed 50% (1,2). Patients often require transfer to specialized centers for VT management, yet many have end-stage cardiomyopathy or VT/VF that is not amenable to ablation because of deep intramural circuits or multiple pleomorphic VTs. Some are not candidates for cardiac transplantation because of age, comorbidities, or lack of social support. Treatment options are limited for these patients, who can remain hospitalized in intensive care units and receive multiple intravenous antiarrhythmic agents and sedatives.