Should catheter ablation be the preferred therapy for reducing ICD shocks?: Ventricular tachycardia ablation versus drugs for preventing ICD shocks: role of adjuvant antiarrhythmic drug therapy.

In 1980, Mirowski et al1 implanted the first implantable cardioverter-defibrillator (ICD) in a young female with recurrent ventricular fibrillation and provided an innovative approach to aborted sudden cardiac death (SCD). Although the ICD was considered a treatment of last resort during that incipient stage, subsequent years have witnessed prolific expansion of indications for ICD implantation.2 Several large-scale clinical trials have demonstrated its efficacy for both primary and secondary prevention of SCD in patients with ischemic and nonischemic cardiomyopathy.3,4 ICD therapy in such high-risk patients has been shown to improve survival compared with conventional antiarrhythmic drug therapy alone.3,4 The number of ICD implantations has increased significantly in the last decade, with a concurrent decrease in the use of stand-alone antiarrhythmic drugs for ventricular indications.5–7 Current ICDs have sophisticated programming capabilities, atrial and bipolar leads, and are able to deliver antitachycardia pacing algorithms (ATP) in addition to defibrillating shocks.