Ablation of Stable VTs Versus Substrate Ablation in Ischemic Cardiomyopathy the VISTA Randomized Multicenter Trial

Gemma Pelargonio, Antonio Dello Russo, Michela Casella, Luigi Di Biase, J. David Burkhardt, Dhanujaya Lakkireddy, Corrado Carbucicchio, Sanghamitra Mohanty, Prasant Mohanty, Chintan Trivedi, Rong Bai, Giovanni Forleo, Rodney Horton, Shane Bailey, Javier Sanchez, Amin Al-Ahmad, Patrick Hranitzky, G. Joseph Gallinghouse, Richard H. Hongo, Salwa BeheirySteven C. Hao, Madhu Reddy, Antonio Rossillo, Sakis Themistoclakis, Andrea Natale

Risultato della ricerca: Contributo in rivistaArticolo in rivista

175 Citazioni (Scopus)

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)
Lingua originaleEnglish
pagine (da-a)2872-2882
Numero di pagine11
RivistaJOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Volume66
DOI
Stato di pubblicazionePubblicato - 2015

Keywords

  • Aged
  • Body Surface Potential Mapping
  • Cardiomyopathies
  • Catheter Ablation
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Myocardial Ischemia
  • Recurrence
  • Retrospective Studies
  • Tachycardia, Ventricular
  • Time Factors
  • Treatment Outcome
  • amiodarone
  • catheter ablation
  • ischemic cardiomyopathy
  • myocardial infarction
  • outcomes
  • ventricular tachycardia

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