Long-Term Success of Irrigated Radiofrequency Catheter Ablation of Sustained Ventricular Tachycardia: Post-Approval THERMOCOOL VT Trial

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• 作者：Francis E. Marchlinski ; MD^a ; ^{francis.marchlinski@uphs.upenn.edu" class="auth_mail" title="E-mail the corresponding author} ; Charles I. Haffajee ; MBBS ; MD^b ; John F. Beshai ; MD^c ; Timm-Michael L. Dickfeld ; MD ; PhD^d ; Mario D. Gonzalez ; MD^e ; Henry H. Hsia ; MD^f ; Claudio D. Schuger ; MD^g ; Karen J. Beckman ; MD^h ; Frank M. Bogun ; MDⁱ ; Scott J. Pollak ; MD^j ; Anil K. Bhandari ; MD^k
• 关键词：catheter ablation ; quality of life ; radiofrequency ; safety ; ThermoCool ; ventricular tachycardia
• 刊名：Journal of the American College of Cardiology
• 出版年：2016
• 出版时间：16 February 2016
• 年：2016
• 卷：67
• 期：6
• 页码：674-683
• 全文大小：837 K

文摘

Radiofrequency catheter ablation is used to treat recurrent ventricular tachycardia (VT).

Objectives

This study evaluated long-term safety and effectiveness of radiofrequency catheter ablation using an open-irrigated catheter.

Methods

Patients with sustained monomorphic ventricular tachycardia associated with coronary disease were analyzed for cardiovascular-specific adverse events within 7 days of treatment, hospitalization duration, 6-month sustained monomorphic ventricular tachycardia recurrence, quality of life measured by the Hospital Anxiety and Depression Scale, long-term (1-, 2-, and 3-year) survival, symptomatic VT control, and amiodarone use.

Results

Overall, 249 patients, mean age 67.4 years, were enrolled. The cardiovascular-specific adverse events rate was 3.9% (9 of 233) with no strokes. Noninducibility of targeted VT was achieved in 75.9% of patients. Post-ablation median hospitalization was 2 days. At 6 months, 62.0% (114 of 184) of patients had no sustained monomorphic ventricular tachycardia recurrence; the proportion of patients with implantable cardioverter-defibrillator shocks decreased from 81.2% to 26.8% (p < 0.0001); the frequency of VT in implantable cardioverter-defibrillator patients with recurrences was reduced by ≥50% in 63.8% of patients; and the proportion with normal Hospital Anxiety and Depression Scale scores increased from 48.8% to 69.1% (p < 0.001). Patient-reported VT remained steady for 1, 2, and 3 years at 22.7%, 29.8%, and 24.1%, respectively. Amiodarone use and hospitalization decreased from 55% and 77.2% pre-ablation to 23.3% and 30.7%, 18.5% and 36.7%, 17.7% and 31.3% at 1, 2, and 3 years, respectively.

Conclusions

Radiofrequency catheter ablation reduced implantable cardioverter-defibrillator shocks and VT episodes and improved quality of life at 6 months. A steady 3-year nonrecurrence rate with reduced amiodarone use and hospitalizations indicate improved long-term outcomes. (NaviStar ThermoCool Catheter for Endocardial RF Ablation in Patients With Ventricular Tachycardia [THERMOCOOL VT]; NCT00412607)