A 68-year-old man with ischaemic cardiomyopathy (LVEF 28%) experiences recurrent sustained ventricular tachycardia despite optimal medical therapy including amiodarone. An ICD was placed 6 months ago with multiple appropriate shocks. What additional intervention has been shown to reduce ICD shocks?
- A Adding sotalol to amiodarone
- B Increasing amiodarone dose to 400 mg daily
- C Catheter ablation of the VT focus (endo/epicardial mapping and ablation) ✓
- D Surgical ventricular reconstruction (Dor procedure)
Correct answer: C. Catheter ablation of the VT focus (endo/epicardial mapping and ablation)
Explanation
VT catheter ablation reduces ICD shocks and VT storm in patients with structural heart disease failing antiarrhythmic therapy. The SMASH-VT, VTACH, and VANISH trials demonstrated significant reductions in VT recurrence and ICD therapies with ablation. Combining amiodarone and sotalol is not recommended due to additive QT prolongation and proarrhythmic risk. Escalating amiodarone beyond standard doses adds toxicity. Surgical ventricular reconstruction is for dyskinetic aneurysm, not recurrent VT management primarily.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.