Nonpharmacologic therapy of ventricular tachycardia.

Nonpharmacologic therapies for patients with sustained ventricular tachycardia have been necessitated by the low frequency of drug-responsive patients. These nonpharmacologic therapies include antitachycardia pacemakers, low-energy cardioverters, defibrillators, surgery and, for the present, catheter ablation. Antitachycardia pacing alone should never be used because of the known incidence of acceleration of ventricular tachycardia to ventricular fibrillation. Thus, all electrical devices must include a back-up defibrillator at the very least. The current automatic implantable cardioverter-defibrillator, which has been implanted in over 1000 patients, has been shown to prevent sudden death. Surgery has offered the only method to cure the arrhythmia by removing the arrhythmogenic substrate. Improved surgical techniques with electrophysiologic guidance have an acceptable mortality and a clinical success rate in 80-90% range. Catheter ablation, which is an experimental procedure at this time, offers the promise of a nonsurgical technique to extirpate the ventricular tachycardia substrate.