TY - JOUR
T1 - Ablation of Stable VTs Versus Substrate Ablation in Ischemic Cardiomyopathy the VISTA Randomized Multicenter Trial
AU - Di Biase, Luigi
AU - Burkhardt, J. David
AU - Lakkireddy, Dhanujaya
AU - Carbucicchio, Corrado
AU - Mohanty, Sanghamitra
AU - Mohanty, Prasant
AU - Trivedi, Chintan
AU - Santangeli, Pasquale
AU - Bai, Rong
AU - Forleo, Giovanni
AU - Horton, Rodney
AU - Bailey, Shane
AU - Sanchez, Javier
AU - Al-Ahmad, Amin
AU - Hranitzky, Patrick
AU - Gallinghouse, G. Joseph
AU - Pelargonio, Gemma
AU - Hongo, Richard H.
AU - Beheiry, Salwa
AU - Hao, Steven C.
AU - Reddy, Madhu
AU - Rossillo, Antonio
AU - Themistoclakis, Sakis
AU - Dello Russo, Antonio
AU - Casella, Michela
AU - Tondo, Claudio
AU - Natale, Andrea
N1 - Publisher Copyright:
© 2015 American College of Cardiology Foundation.
PY - 2015/12/29
Y1 - 2015/12/29
N2 - 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.
AB - 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.
KW - amiodarone
KW - catheter ablation
KW - ischemic cardiomyopathy
KW - myocardial infarction
KW - outcomes
KW - ventricular tachycardia
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U2 - 10.1016/j.jacc.2015.10.026
DO - 10.1016/j.jacc.2015.10.026
M3 - Article
C2 - 26718674
AN - SCOPUS:84955447645
SN - 0735-1097
VL - 66
SP - 2872
EP - 2882
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 25
ER -