Coronary artery disease (CAD), a common disease with high incidence and mortality rate, has seriously threatened the health and life of the public. Risk factors, like atherogenic dyslipidemia, chronic inflammation, insulin resistance, and uncontrolled hypertension, are all contributed to the final CAD. The main clinical manifestations are presented as angina pectoris or myocardial infarction, and patients eventually might die of heart failure or ventricular tachycardia / ventricular fibrillation.

Coronary artery stenosis leads to ischemia even necrosis of myocardium. However, the intricate communication of the small branches of the coronary arteries leads to the injured myocardium being intertwined with viable tissue. Once the electrical activity comes to this complicated and devastated area, the propagation speed varies and generate ventricular premature beats, which might eventually evolve into ventricular tachycardia(VT) or even ventricular fibrillation(VF), during which the patients might suffer palpitations, shortness of breath, syncope, and even cardiac death.

For those patients who had experienced VT, in addition to oral anti-arrhythmia medication, for example, amiodarone, sotalol and other drugs to control the rhythm, an implantable cardioverter defibrillator (ICD) should also be evaluated, especially for those with history of syncope or were believed might suffer high risk of sudden cardiac death in the near future. The ICD is a life-saving therapy when malignant VT occurs by giving shocks to accomplish electrical cardioversion, and it is the first-line therapy recommended by the current guidelines. However, it could do nothing to the original lesion that cause VT. Moreover, the financial burden and device-shock-related pain also make patients hesitate when choose an ICD. What’s more, the recurrent shocks during a short time might also cause the deterioration of heart failure.

Catheter ablation is another important therapeutic option with the potential to cure VT. In our center, the ablation of VT has been practiced for over ten years and largest series of cases in Asia has been collected and safety, effectiveness, and high success rates has been witnessed. However, based on the pathogenesis of VT, the new lesion might occur and new VT might also emerge, and the long-term effectiveness still remains to be seen. At present, it is mainly used for patients with few lesions and relatively normal cardiac function.

Theoretically, CAD patients that are believed suffering the high risk of sudden cardiac death in the near future should be recommended with ICD implantation followed by radiofrequency ablation to minimize the risk of VT attacks. Nevertheless, it costs relatively too much, usually up to 130,000 to 150,000 RMB.