Ablation of Stable VTs Versus Substrate Ablation in Ischemic Cardiomyopathy the VISTA Randomized Multicenter Trial
Articolo
Data di Pubblicazione:
2015
Citazione:
Ablation of Stable VTs Versus Substrate Ablation in Ischemic Cardiomyopathy the VISTA Randomized Multicenter Trial / L. Di Biase, J..D. Burkhardt, D. Lakkireddy, C. Carbucicchio, S. Mohanty, P. Mohanty, C. Trivedi, P. Santangeli, R. Bai, G. Forleo, R. Horton, S. Bailey, J. Sanchez, A. Al-Ahmad, P. Hranitzky, G..J. Gallinghouse, G. Pelargonio, R.H. Hongo, S. Beheiry, S.C. Hao, M. Reddy, A. Rossillo, S. Themistoclakis, A. Dello Russo, M. Casella, C. Tondo, A. Natale. - In: JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY. - ISSN 0735-1097. - 66:25(2015), pp. 2872-2882. [10.1016/j.jacc.2015.10.026]
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.
Tipologia IRIS:
01 - Articolo su periodico
Keywords:
amiodarone; catheter ablation; ischemic cardiomyopathy; myocardial infarction; outcomes; ventricular tachycardia; 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; Cardiology and Cardiovascular Medicine
Elenco autori:
D.B. Luigi, B. J. David, L. Dhanujaya, C. Corrado, M. Sanghamitra, M. Prasant, T. Chintan, S. Pasquale, B. Rong, F. Giovanni, H. Rodney, B. Shane, S. Javier, A. Amin, H. Patrick, G. G. Joseph, P. Gemma, H. Richard H., B. Salwa, H. Steven C., R. Madhu, R. Antonio, T. Sakis, D.R. Antonio, C. Michela, C. Tondo, A. Natale
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