Ablation of Stable VTs Versus Substrate Ablation in Ischemic Cardiomyopathy: The VISTA Randomized Multicenter Trial (original) (raw)
Related papers
Journal of the American Heart Association, 2018
Ventricular tachycardia (VT) causes significant morbidity and mortality. Implantable cardioverter-defibrillator shocks terminate VT but confer a significant morbidity and mortality risk. Therefore, VT ablation is increasingly common. Patients with structural heart disease (SHD) and patients with structurally normal hearts as well as the subgroup with and without ischemic heart disease were assessed for predictors of mortality and nonfatal VT recurrence. We present the first multicenter, prospective German VT registry. In 334 patients, 118 structurally normal hearts and 216 SHD (74.5% ischemic heart disease), referred for VT ablation in 38 centers, long-term follow-up was assessed for a minimum of 12 months and analyzed for factors predicting VT recurrence rates and mortality. The VTs in SHD patients were more frequently hemodynamically unstable (34.7% versus 12.7%, <0.0001) or incessant (9.7% versus 2.7%, <0.05). More SHD patients underwent substrate modification than patients...
Circulation. Arrhythmia and electrophysiology, 2017
Noninducibility of sustained monomorphic ventricular tachycardia (SMVT) postablation does not insure absence of later recurrence in patients with ischemic cardiomyopathy. This study aims to determine the relation between inducible nonsustained VT postablation and VT recurrences. One hundred sixty-five consecutive patients (156 male; age 68±9 years) underwent ablation for SMVT because of ischemic cardiomyopathy; 44 patients who did not have induction testing or in whom only ventricular fibrillation was induced after ablation were excluded. In 38 patients (23%), SMVT was inducible (group C). Of the 83 patients without inducible SMVT after ablation, nonsustained VT defined as ≥5 beats lasting for <30 s, was induced in 34 patients (group B, 21%), whereas the remaining 49 patients had no VT induced by the induction test (group A, 30%). Over a median follow-up of 18.7 months, freedom from recurrent VT at 24 months was 60% in group A, 45% in group B (P=0.017 versus group A), and 38% in ...
New Trends in High Risk Ventricular Tachycardia Catheter Ablation
Journal of Cardiovascular Disease Research, 2019
Ventricular tachycardia (VT) is one of the major causes of sudden cardiac death (SCD). In general, VT could be managed with antiarrhythmic drugs (AADs) therapy, catheter ablation and implantable cardioverter defibrillators (ICD). While the AADs therapy and catheter ablation have been shown to reduce the recurrence of VT, only the ICD therapy is effective in aborting SCD. The recently published VANISH trial reveals that VT catheter ablation significantly decreases the rate of death, VT storm and appropriate ICD shock comparing with an escalation of AADs therapy for ischemic cardiomyopathy (ICM). However, the mapping strategies and feasibility of VT catheter ablation are often limited by the hemodynamically intolerant VT. Substrate modification strategy and percutaneous left ventricular assist device (pLVAD) are often used to overcome the hemodynamic intolerance. So far there are no large-scale randomized clinical trials comparing different mapping strategies in the setting of hemodynamically unstable VT, specifically when it comes to risk stratification for patients with hemodynamic instability. The aim of the present article is to systemically review different VT mapping strategies, the role of pLVAD in hemodynamically intolerant VT ablation with a special consideration of high risk VT.
2013
at Subscriptions: Information about subscribing to Circulation: Arrhythmia and Electrophysiology is online by guest on April 16, 2013 circep.ahajournals.org Downloaded from 351 I n patients with ischemic cardiomyopathy (ICM), ventricular tachycardia (VT) is associated with poor long-term outcomes. 1 Three secondary prevention studies have shown the unequivocal benefit of implantable cardioverter-defibrillators (ICD) in patients with previous myocardial infarction and impaired left ventricular ejection fraction. 2-4 These studies, however, excluded patients with stable VT or with left ventricular ejection fraction >40%. Analysis from the antiarrhythmics versus implantable defibrillators registry, 5 however, suggests that clinically well-tolerated VT carries a poor prognosis as well. ICDs are therefore recommended in patients with previous myocardial infarction and sustained VT. 6 Although ICDs improve overall survival, they do not eliminate the substrate responsible for sustained arrhythmia. ICD without ablation carries a higher risk of shocks, 7,8 and shocks are associated with decreased quality of life and increased mortality. 9 VT ablation, on the contrary, reduces or even abolishes VT episodes in some patients. Currently, guidelines suggest that VT ablation to be used as an adjunct to ICD. 10 It is not known whether some patients presenting with VT can be treated by ablation alone.
Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2014
The purpose of this study was to evaluate the outcomes of purely substrate-guided ventricular tachycardia (VT) ablation in patients with non-ischaemic dilated cardiomyopathy (NIDCM) and ischaemic cardiomyopathy (ICM) and the impact of acute procedural success on long-term outcome. One hundred and forty-two patients (65 ± 12 years old, 72% male) with ICM (n = 87) and with NIDCM (n = 55) underwent substrate-guided VT ablation. The ablation approach involved eliminating all LP regions and ablating all scar border zone regions with 10 or more out of 12 pace-matching. All patients were followed with regular implantable defibrillator interrogations for mean 641 ± 301 days. Complete acute success (no inducible VT) was achieved in 60 patients with ICM (69%) and in 29 patients with NIDCM (53%) (P = 0.03). Partial success (elimination of clinical VT only) was obtained in nine patients with ICM (10%) and in four patients with NIDCM (7%) (P = 0.14). Procedural failure (clinical VT still inducib...
Nationwide survey on the current practice of ventricular tachycardia ablation
Journal of Cardiovascular Medicine, 2019
Methods We performed a nationwide survey on the current practice of ventricular tachycardia catheter ablation in Italy during the year 2016. Results Among 145 operators participating in the survey, 58 (40.0%) did not perform any ventricular tachycardia ablation in 2016. Among those performing ventricular tachycardia ablation, 9 operators (6.2%) performed only right ventricular endocardial catheter ablation, 52 (35.9%) performed endocardial catheter ablation both in the right and left ventricle (LV) and 26 (17.9%) performed both endocardial and epicardial LV catheter ablations. Seventy operators (89.7%) among the 78 performing LV and epicardial ablations treated patients with ischemic cardiomyopathy; ablations in the setting of other causes were less frequently performed. The following were considered as minimum requirements for ventricular tachycardia ablation: presence of a three-dimensional mapping system (120 operators, 82.8%), ICU in the hospital (118 operators, 81.4%), operator's training in high volume centers (93 operators, 64.1%). Twenty-eight operators (19.3%) performed catheter ablation in patients with electrical storm only after hemodynamic stabilization, 41 operators (28.3%) also during the acute phase and 9 operators (6.2%) never performed catheter ablation in electrical storm patients; the remaining 67 operators did not perform ventricular tachycardia ablation at all, or performed ablations only in the right ventricle. Conclusion The present survey provides a snapshot of the current invasive treatment of ventricular tachycardia by catheter ablation. The procedure, especially in the setting of ischemic cardiomyopathy, is performed nationwide. Complex cases, including those with electrical storm, should be managed within a preestablished integrated network of regional referral centers able to transfer patients as soon as possible.
Treatment of ventricular tachycardia: consider ablation sooner
F1000 medicine reports, 2009
Ventricular tachycardia (VT) is a leading cause of morbidity and mortality for many patients, with a significant emotional and economic burden caused by implantable cardioverter-defibrillator (ICD) shocks and the requirement of medication with significant side effects. Additionally, 10% of VT occurs in patients with no structural heart disease. Until quite recently, ablation for VT has been reserved as the procedure of last hope for those who have ongoing recurrences despite maximal medical therapy and who are traumatized by multiple ICD shocks [1]. However, recent advances in imaging technology and three-dimensional intracardiac mapping systems have significantly improved the safety and efficacy of VT ablation procedures. Thus, ablation for VT should no longer be reserved as a last-resort bailout procedure and should move into the realm of routine electrophysiology treatment.