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J Am Coll Cardiol. 2015 Dec 29;66(25):2872-2882. doi: 10.1016/j.jacc.2015.10.026.

Ablation of Stable VTs Versus Substrate Ablation in Ischemic Cardiomyopathy: The VISTA Randomized Multicenter Trial.

Author information

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).

KEYWORDS:

amiodarone; catheter ablation; ischemic cardiomyopathy; myocardial infarction; outcomes; ventricular tachycardia

PMID:
26718674
DOI:
10.1016/j.jacc.2015.10.026
[Indexed for MEDLINE]
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