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

被引：243

作者：

Di Biase, Luigi ^{[1
,2
,3
,4
]}

Burkhardt, J. David ^{[1
]}

Lakkireddy, Dhanujaya ^{[5
]}

Carbucicchio, Corrado ^{[6
]}

Mohanty, Sanghamitra ^{[1
]}

Mohanty, Prasant ^{[1
]}

Trivedi, Chintan ^{[1
]}

Santangeli, Pasquale ^{[4
,7
]}

Bai, Rong ^{[1
,8
]}

Forleo, Giovanni ^{[9
]}

Horton, Rodney ^{[1
]}

Bailey, Shane ^{[1
]}

Sanchez, Javier ^{[1
]}

Al-Ahmad, Amin ^{[1
]}

Hranitzky, Patrick ^{[1
]}

Gallinghouse, G. Joseph ^{[1
]}

Pelargonio, Gemma ^{[10
]}

Hongo, Richard H. ^{[11
]}

Beheiry, Salwa ^{[11
]}

Hao, Steven C. ^{[11
]}

Reddy, Madhu ^{[5
]}

Rossillo, Antonio ^{[12
]}

Themistoclakis, Sakis ^{[12
]}

Dello Russo, Antonio ^{[6
]}

Casella, Michela ^{[6
]}

Tondo, Claudio ^{[6
]}

Natale, Andrea ^{[1
,3
,11
,13
,14
,15
,16
]}

机构：

[1] St Davids Med Ctr, Texas Cardiac Arrhythmia Inst, Austin, TX USA

[2] Montefiore Hosp, Albert Einstein Coll Med, Bronx, NY USA

[3] Univ Texas Austin, Dept Biomed Engn, Austin, TX 78712 USA

[4] Univ Foggia, Dept Cardiol, Foggia, Italy

[5] Univ Kansas, Kansas City, KS USA

[6] Ctr Cardiol Monzino IRCCS, Cardiac Arrhythmia Res Ctr, Milan, Italy

[7] Univ Penn, Philadelphia, PA 19104 USA

[8] Capital Med Univ, Beijing Anzhen Hosp, Dept Cardiol, Beijing, Peoples R China

[9] Univ Roma Tor Vergata, Rome, Italy

[10] Univ Cattolica Sacro Cuore, I-00168 Rome, Italy

[11] Calif Pacific Med Ctr, San Francisco, CA USA

[12] Osped Angelo, Mestre Venice, Italy

[13] Stanford Univ, Div Cardiol, Palo Alto, CA 94304 USA

[14] Case Western Reserve Univ, Cleveland, OH 44106 USA

[15] Scripps Clin, San Diego, CA USA

[16] Dell Med Sch, Austin, TX USA

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2015年 / 66卷 / 25期

关键词：

amiodarone; catheter ablation; ischemic cardiomyopathy; myocardial infarction; outcomes; ventricular tachycardia; VENTRICULAR-TACHYCARDIA ABLATION; RADIOFREQUENCY CATHETER ABLATION; MYOCARDIAL-INFARCTION; HEART-DISEASE; SINUS RHYTHM; ARRHYTHMIAS; SCAR; THERAPY; DEFIBRILLATORS; POTENTIALS;

D O I：

10.1016/j.jacc.2015.10.026

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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) (C) 2015 by the American College of Cardiology Foundation.

引用

页码：2872 / 2882

页数：11

共 28 条

[1] Isolated potentials during sinus rhythm and pace-mapping within scars as guides for ablation of post-infarction ventricular tachycardia [J].