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©2013 UpToDate ® Print Email Recommendations for radiofrequency catheter ablation Ablation should be performed in the following settings: 1. Patients otherwise at low risk for sudden cardiac death who have sustained monomorphic VT, when the VT is drug resistant, or the patient is drug intolerant or does not desire long-term drug therapy. 2. Patients with bundle branch reentrant VT. 3. As adjunctive therapy for patients with an ICD who are receiving multiple shocks as a result of sustained VT that is not manageable by reprogramming or changing drug therapy or the patient does not wish long-term drug therapy. 4. Ablation is indicated in patients with WPW syndrome resuscitated from sudden cardiac arrest due to AF and rapid conduction over the accessory pathway causing VF. It is reasonable to perform ablation in the following settings: 1. Patients who are otherwise at low risk for sudden cardiac death and have symptomatic nonsustained monomorphic VT, when the tachycardia is drug resistant or the patient is drug intolerant or does not desire long-term drug therapy. 2. Patients who are otherwise at low risk for sudden cardiac death and have frequent symptomatic predominantly monomorphic PVCs when the PVCs are drug resistant, or the patient is drug intolerant or does not wish long-term drug therapy. 3. Patients with symptomatic WPW syndrome who have accessory pathways with refractory periods less than 240 ms in duration. Ablation may be considered in the following settings: 1. Ablation of Purkinge fiber potentials may be considered in patients with ventricular arrhythmia storm consistently provoked by PVCs of similar morphology. 2. Ablation of asymptomatic PVCs may be considered when the PVCs are very frequent to avoid or treat tachycardia-induced cardiomyopathy. Ablation should NOT be performed in the following setting: 1. Asymptomatic and clinically benign nonsustained VT. VT: ventricular tachycardia; WPW: Wolff-Parkinson-White syndrome; VF: ventricular fibrillation; AF: atrial fibrillation; ICD: implantable cardioverter-defibrillator; PVC: premature ventricular contraction.

2. Ablation of asymptomatic PVCs may be considered when the PVCs are very frequent to avoid or treat tachycardia-induced cardiomyopathy. Ablation should NOT be performed in the following setting: 1. Asymptomatic and clinically benign nonsustained VT. VT: ventricular tachycardia; WPW: Wolff-Parkinson-White syndrome; VF: ventricular fibrillation; AF: atrial fibrillation; ICD: implantable cardioverter-defibrillator; PVC: premature ventricular contraction. Data from Zipes DP, Camm AJ, Borggrefe M, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death). J Am Coll Cardiol 2006; 48:e247.