Role of Ventricular Tachycardia Surgery and Catheter Ablation As Complements or Alternatives To the Implantable Cardioverter Defibrillator in the 1990s

Although the implantable cardioverter defibrillator is used increasingly, other nonpharmacological approaches have their indications and merits. Furthermore, as the natural history of ventricular tachyarrhythmias or their underlying structural cardiac abnormality, i.e., coronary artery disease, dilated cardiomyopathy, arrhythmogenic right ventricular disease, etc. change, the mode of therapy may be modified accordingly. Because of the disappointing results of the CAST study in previously asymptomatic patients after myocardial infarction and the evidence that failure of one or two antiarrhythmic drugs tested by programmed ventricular stimulation in patients with documented sustained ventricular tachycardia or fibrillation predicts further drug failure, there will be a significant increase in the use of implantable cardioverters defibrillators in the 1990s. However, care should be taken to avoid inappropriate use of these devices.