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Although the risk of sudden death associated with ventricular arrhythmia in patients with structural heart disease is significantly reduced by the use of implantable cardioverter defibrillators (ICDs) these devices do not reduce the frequency of ventricular tachycardia (VT), which can result in decreased quality of life.1 Antiarrhythmic agents do reduce shock frequency but their use is limited by disappointing efficacy and side effects.2 Therefore, the improvement in quality of life associated with catheter ablation of VT has made this procedure even more important as use of ICDs has dramatically increased. Catheter ablation, however, remains underused with many patients having to go through episodes of VT storm and multiple ICD therapies before being referred, if they are ever referred at all. The low referral rates may be because catheter ablation of VT is considered a high risk and complex treatment; however, the short- and medium-term results are excellent when carried out at high-volume centres.3 Another explanation may be the increase in ICD implantation outside main electrophysiology centres. This is undoubtedly a good thing for patients as the ICD implants are performed with few complications, patients do not have to travel and implant rates increase. There is, however, a danger that some implanting centres may not be familiar with the more complex therapeutic options available to their patients when things go wrong.
Attention has been drawn to catheter ablation of VT by the publication of guidelines by the National Institute for Clinical Excellence (NICE) examining the role of percutaneous (non-thoracoscopic) epicardial catheter …