Scar Homogenization for Treatment of Ventricular Tachycardia

While 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.

Subjects with ischemic cardiomyopathy and hemodynamically tolerated VT (n = 60) were randomized to clinical ablation versus all "abnormal" electrograms in the scar (n = 58) that were targeted by substrate-based ablation.


Primary Endpoint:

●     Recurrence of VT


Secondary endpoints:

●     Periprocedural complications

●     12-month mortality

●     Rehospitalizations


At 12-month follow-up:

●     29 (48.3%) patients had VT recurrence in the clinical VT ablation group vs 9 (15.5%) in the substrate-based group (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%; 15.0% in clinical ablation and  8.6% in substrate ablation groups, respectively (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)


Conclusion:
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.


Di Biase L, Burkhardt JD, Lakkireddy D, Carbucicchio C, Mohanty S, Mohanty P, Trivedi C, Santangeli P, Bai R, Forleo G, Horton R, Bailey S, Sanchez J, Al-Ahmad A, Hranitzky P, Gallinghouse GJ, Pelargonio G, Hongo RH, Beheiry S, Hao SC, Reddy M, Rossillo A, Themistoclakis S, Dello Russo A, Casella M, Tondo C and Natale A. Ablation of Stable VTs Versus Substrate Ablation in Ischemic Cardiomyopathy: The VISTA Randomized Multicenter Trial. J Am Coll Cardiol. 2015;66:2872-2882. NCT01045668

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