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BACKGROUND-Patients with heart failure who receive an implantable cardioverterdefibrillator (ICD) for primary prevention (i.e., prevention of a first life-threatening arrhythmic event) may later receive therapeutic shocks from the ICD. Information about long-term prognosis after ICD therapy in such patients is limited.

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TRIAL FIBRILLATION (AF) REPresents an important public health problem. Patients with AF have an increased longterm risk of stroke, heart failure, and all-cause mortality. [1][2][3][4] Furthermore, patients with AF describe a considerably impaired quality of life (QOL) that is independent of the severity of the disease. 5,6 Restoration and maintenance of normal sinus rhythm following treat-ment directly correlates with improved QOL in these patients. [5][6][7][8] Although antiarrhythmic drugs are generally used as first-line therapy to treat patients with AF, effectiveness remains inconsistent. The likelihood of AF recurrence within 6 to 12 months approaches 50% with most drugs. [9][10][11] Antiarrhythmic drugs are also associ-ated with cumulative adverse effects over time. 1 Catheter ablation has accordingly become an alternative therapy for AF. 12 Several recent studies have See also Patient Page.

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Background-Recurrent ventricular tachycardia (VT) is an important cause of mortality and morbidity late after myocardial infarction. With frequent use of implantable cardioverter-defibrillators, these VTs are often poorly defined and not tolerated for mapping, factors previously viewed as relative contraindications to ablation. This observational multicenter study assessed the outcome of VT ablation with a saline-irrigated catheter combined with an electroanatomic mapping system. Methods and Results-Two hundred thirty-one patients (median LV ejection fraction, 0.25; heart failure in 62%) with recurrent episodes of monomorphic VT (median, 11 in the preceding 6 months) caused by prior myocardial infarction were enrolled. All inducible monomorphic VTs with a rate approximating or slower than any spontaneous VTs were targeted for ablation guided by electroanatomic mapping during sinus rhythm and/or VT. Patients were not excluded for multiple VTs (median, 3 per patient) or unmappable VT (present in 69% of patients). Ablation abolished all inducible VTs in 49% of patients. The primary end point of freedom from recurrent incessant VT or intermittent VT after 6 months of follow-up was achieved for 123 patients (53%). In 142 patients with implantable cardioverter-defibrillators before and after ablation for intermittent VT who survived 6 months, VT episodes were reduced from a median of 11.5 to 0 (PϽ0.0001). The 1-year mortality rate was 18%, with 72.5% of deaths attributed to ventricular arrhythmias or heart failure. The procedure mortality rate was 3%, with no strokes. Conclusions-Catheter ablation is a reasonable option to reduce episodes of recurrent VT in patients with prior myocardial infarction, even when multiple and/or unmappable VTs are present. This population remains at high risk for death, warranting surveillance and further study. (Circulation. 2008;118:2773-2782.)

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