Expert consensus on catheter ablation of ventricular arrhythmias

A call to action for more research to be undertaken into catheter ablation in the field of ventricular arrhythmia (VA) has been issued in a joint consensus document from the European Heart Rhythm Association (EHRA) a registered branch of the European Society of Cardiology (ESC) and the US Heart Rhythm Society (HRS). The consensus document - launched at Heart Rhythm 2009, the Heart Rhythm Society's 30th Annual Scientific Sessions, to be held 13 to 16 May in Boston - provides an up to date review of indications, techniques and outcomes of catheter ablation for treatment of ventricular arrhythmias, a technique now being offered to increasing numbers of patients.

"In the last few years there has been a substantial evolution of techniques for catheter ablation in VA. We hope this document will help identify the areas in catheter ablation that require further research, and encourage clinicians to embark on more clinical and registry studies," says Etienne Aliot, the European co-chair from Nancy, France. "It is only by conducting more clinical trials and registries that we can begin to get an idea of exactly how catheter ablation fits into the whole VA treatment paradigm including Implantable Cardio Defibrillators (ICDs) and antiarrhythmic drugs."

The document - authored by 20 leading European and US electrophysiologists - recognises there is still "very limited" data establishing the long term impact of catheter ablation on morbidity and mortality.

Unanswered questions highlighted by the joint document include:

* the long term efficacy of catheter ablation
* the comparative success rates of drug and ablative therapies
* can ablation slow the progression of ventricular remodelling in structural heart disease?
* definition of patients with different underlying cardiac and non cardiac diseases.

"Over the past decade there has been great progress with important advances in methods for mapping and ablating ventricular arrhythmias, but there are also many gaps in our knowledge where more work is needed. EHRA and HRS recognized that a document summarizing where we are now, where there is agreement and where we need to go would be timely and important," says William Stevenson, the US co-chair from Brigham and Women's Hospital, Boston, MA – USA.

The document is the third joint consensus document to be issued by EHRA and HRS at the Heart Rhythm meeting, with EHRA taking the lead this year.

"Having one document between Europe and the US is vitally important since it gives both clinicians and patients the confidence that they are doing the right thing. Having different documents on both sides of the Atlantic is a recipe for confusion," says Professor Aliot.

In an area with few clinical trials, but many single centre reports, the consensus document summarised the opinion of task force members based on their own experience of treating patients, in addition to a review of the literature. For each topic, two members of the task force drafted a discussion document that was then considered and edited by all members of the team.