Luigi Di Biase1, J David Burkhardt2, Dhanujaya Lakkireddy3, Corrado Carbucicchio4, Sanghamitra Mohanty2, Prasant Mohanty2, Chintan Trivedi2, Pasquale Santangeli5, Rong Bai6, Giovanni Forleo7, Rodney Horton2, Shane Bailey2, Javier Sanchez2, Amin Al-Ahmad2, Patrick Hranitzky2, G Joseph Gallinghouse2, Gemma Pelargonio8, Richard H Hongo9, Salwa Beheiry9, Steven C Hao9, Madhu Reddy3, Antonio Rossillo10, Sakis Themistoclakis10, Antonio Dello Russo4, Michela Casella4, Claudio Tondo4, Andrea Natale11. 1. Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas; Albert Einstein College of Medicine, at Montefiore Hospital, Bronx, New York; Department of Biomedical Engineering, University of Texas, Austin, Texas; Department of Cardiology, University of Foggia, Foggia, Italy. 2. Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas. 3. University of Kansas, Kansas City, Kansas. 4. Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy. 5. Department of Cardiology, University of Foggia, Foggia, Italy; University of Pennsylvania, Philadelphia, Pennsylvania. 6. Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas; Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China. 7. University of Tor Vergata, Rome, Italy. 8. University of Sacred Heart, Rome, Italy. 9. California Pacific Medical Center, San Francisco, California. 10. Ospedale dell'Angelo, Mestre Venice, Italy. 11. Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas; Department of Biomedical Engineering, University of Texas, Austin, Texas; California Pacific Medical Center, San Francisco, California; Division of Cardiology, Stanford University, Palo Alto, California; Case Western Reserve University, Cleveland, Ohio; Scripps Clinic, San Diego, California; Dell Medical School, Austin, Texas. Electronic address: dr.natale@gmail.com.
Abstract
BACKGROUND:Catheter ablation reduces ventricular tachycardia (VT) recurrence and implantable cardioverter defibrillator shocks in patients with VT and ischemic cardiomyopathy. The most effective catheter ablation technique is unknown. OBJECTIVES: This study determined rates of VT recurrence in patients undergoing ablation limited to clinical VT along with mappable VTs ("clinical ablation") versus substrate-based ablation. METHODS:Subjects with ischemic cardiomyopathy and hemodynamically tolerated VT were randomized to clinical ablation (n = 60) versus substrate-based ablation that targeted all "abnormal" electrograms in the scar (n = 58). Primary endpoint was recurrence of VT. Secondary endpoints included periprocedural complications, 12-month mortality, and rehospitalizations. RESULTS: At 12-month follow-up, 9 (15.5%) and 29 (48.3%) patients had VT recurrence in substrate-based and clinical VT ablation groups, respectively (log-rank p < 0.001). More patients undergoing clinical VT ablation (58%) were on antiarrhythmic drugs after ablation versus substrate-based ablation (12%; p < 0.001). Seven (12%) patients with substrate ablation and 19 (32%) with clinical ablation required rehospitalization (p = 0.014). Overall 12-month mortality was 11.9%; 8.6% in substrate ablation and 15.0% in clinical ablation groups, respectively (log-rank p = 0.21). Combined incidence of rehospitalization and mortality was significantly lower with substrate ablation (p = 0.003). Periprocedural complications were similar in both groups (p = 0.61). CONCLUSIONS: An extensive substrate-based ablation approach is superior to ablation targeting only clinical and stable VTs in patients with ischemic cardiomyopathy presenting with tolerated VT. (Ablation of Clinical Ventricular Tachycardia Versus Addition of Substrate Ablation on the Long Term Success Rate of VT Ablation (VISTA); NCT01045668).
RCT Entities:
BACKGROUND: Catheter ablation reduces ventricular tachycardia (VT) recurrence and implantable cardioverter defibrillator shocks in patients with VT and ischemic cardiomyopathy. The most effective catheter ablation technique is unknown. OBJECTIVES: This study determined rates of VT recurrence in patients undergoing ablation limited to clinical VT along with mappable VTs ("clinical ablation") versus substrate-based ablation. METHODS: Subjects with ischemic cardiomyopathy and hemodynamically tolerated VT were randomized to clinical ablation (n = 60) versus substrate-based ablation that targeted all "abnormal" electrograms in the scar (n = 58). Primary endpoint was recurrence of VT. Secondary endpoints included periprocedural complications, 12-month mortality, and rehospitalizations. RESULTS: At 12-month follow-up, 9 (15.5%) and 29 (48.3%) patients had VT recurrence in substrate-based and clinical VT ablation groups, respectively (log-rank p < 0.001). More patients undergoing clinical VT ablation (58%) were on antiarrhythmic drugs after ablation versus substrate-based ablation (12%; p < 0.001). Seven (12%) patients with substrate ablation and 19 (32%) with clinical ablation required rehospitalization (p = 0.014). Overall 12-month mortality was 11.9%; 8.6% in substrate ablation and 15.0% in clinical ablation groups, respectively (log-rank p = 0.21). Combined incidence of rehospitalization and mortality was significantly lower with substrate ablation (p = 0.003). Periprocedural complications were similar in both groups (p = 0.61). CONCLUSIONS: An extensive substrate-based ablation approach is superior to ablation targeting only clinical and stable VTs in patients with ischemic cardiomyopathy presenting with tolerated VT. (Ablation of Clinical Ventricular Tachycardia Versus Addition of Substrate Ablation on the Long Term Success Rate of VT Ablation (VISTA); NCT01045668).
Authors: Edmond M Cronin; Frank M Bogun; Philippe Maury; Petr Peichl; Minglong Chen; Narayanan Namboodiri; Luis Aguinaga; Luiz Roberto Leite; Sana M Al-Khatib; Elad Anter; Antonio Berruezo; David J Callans; Mina K Chung; Phillip Cuculich; Andre d'Avila; Barbara J Deal; Paolo Della Bella; Thomas Deneke; Timm-Michael Dickfeld; Claudio Hadid; Haris M Haqqani; G Neal Kay; Rakesh Latchamsetty; Francis Marchlinski; John M Miller; Akihiko Nogami; Akash R Patel; Rajeev Kumar Pathak; Luis C Saenz Morales; Pasquale Santangeli; John L Sapp; Andrea Sarkozy; Kyoko Soejima; William G Stevenson; Usha B Tedrow; Wendy S Tzou; Niraj Varma; Katja Zeppenfeld Journal: J Interv Card Electrophysiol Date: 2020-10 Impact factor: 1.900
Authors: Phillip S Cuculich; Matthew R Schill; Rojano Kashani; Sasa Mutic; Adam Lang; Daniel Cooper; Mitchell Faddis; Marye Gleva; Amit Noheria; Timothy W Smith; Dennis Hallahan; Yoram Rudy; Clifford G Robinson Journal: N Engl J Med Date: 2017-12-14 Impact factor: 91.245