Interactions of interventional antiarrhythmic therapies with individual diseases and their substrate: the next challenge in improving patient outcomes

Excerpt

Interventions for the treatment of cardiac arrhythmias continued their global growth in robust fashion in 2013. Estimates for cardiac rhythm management devices continue to show projected growth rates from 9.3 to 11.1 % annually depending on the global region [1]. Catheter ablation for the treatment of tachycardias could top 650,000 procedures annually by 2015 with an expected continuing annual growth rate of 13.4 % [2, 3]. This growth is in part fueled by the expansion of the target patient populations and disease states for interventions. Accompanying the galloping growth of electrophysiological interventions now is the availability of increasingly robust datasets that can examine the nature and/or extent of the intervention with respect to patient outcomes. In the last few years, some important cautionary flags have begun to appear. High energy shocks, when frequently delivered by cardiac implantable electronic devices (CIEDs), can be associated with poorer survival in high-risk populations treated for the primary prevention of sudden death. Lower response rates to cardiac resynchronization therapy have been identified in patients with left ventricular leads implanted in many epicardial locations. Loss of atrial contractile function after extensive left atrial substrate ablation using radiofrequency energy has been documented. …