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

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• 作者：Luigi Di Biase ; MD ; PhD^&lowast ; ; ^&dagger ; ; ^&Dagger ; ; ^§ ; ; J. David Burkhardt ; MD^&lowast ; ; Dhanujaya Lakkireddy ; MD^‖ ; Corrado Carbucicchio ; MD^¶ ; ; Sanghamitra Mohanty ; MD^&lowast ; ; Prasant Mohanty ; MBBS ; MPH^&lowast ; ; Chintan Trivedi ; MD ; MBBS^&lowast ; ; Pasquale Santangeli ; MD^§ ; ; ^# ; Rong Bai ; MD^&lowast ; ; ^&lowast ; &lowast ; ; Giovanni Forleo ; MD^&dagger ; &dagger ; ; Rodney Horton ; MD^&lowast ; ; Shane Bailey ; MD^&lowast ; ; Javier Sanchez ; MD^&lowast ; ; Amin Al-Ahmad ; MD^&lowast ; ; Patrick Hranitzky ; MD^&lowast ; ; G. Joseph Gallinghouse ; MD^&lowast ; ; Gemma Pelargonio ; MD^&Dagger ; &Dagger ; ; Richard H. Hongo ; MD^§ ; § ; ; Salwa Beheiry ; RN^§ ; § ; ; Steven C. Hao ; MD^§ ; § ; ; Madhu Reddy ; MD^‖ ; Antonio Rossillo ; MD^‖‖ ; Sakis Themistoclakis ; MD^‖‖ ; Antonio Dello Russo ; MD^¶ ; ; Michela Casella ; MD^¶ ; ; Claudio Tondo ; MD^¶ ; ; Andrea Natale ; MD^&lowast ; ; ^&Dagger ; ; ^§ ; § ; ; ^¶ ; ¶ ; ; ^## ; ^&lowast ; &lowast ; &lowast ; ; ^&dagger ; &dagger ; &dagger ; ; ^{dr.natale@gmail.com" class="auth_mail" title="E-mail the corresponding author}
• 关键词：amiodarone ; catheter ablation ; ischemic cardiomyopathy ; myocardial infarction ; outcomes ; ventricular tachycardia
• 刊名：Journal of the American College of Cardiology
• 出版年：2015
• 出版时间：29 December 2015
• 年：2015
• 卷：66
• 期：25
• 页码：2872-2882
• 全文大小：2107 K

文摘

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)