Ablation of Stable VTs Versus Substrate Ablation in Ischemic Cardiomyopathy The VISTA Randomized Multicenter Trial
Ablation of Stable VTs Versus Substrate Ablation in Ischemic Cardiomyopathy The VISTA Randomized Multicenter Trial
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DOI：
10.1016/j.jacc.2015.10.026
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发表时间：
2015-12-29
影响因子：
24
通讯作者：
Natale, Andrea
中科院分区：
文献类型：
--
作者：
Di Biase, Luigi;Burkhardt, J. David;Natale, Andrea
背景：在室性心动过速（VT）和缺血性心肌病患者中，导管消融可减少VT复发和植入式心律转复除颤器电击。最有效的导管消融技术尚不清楚。结论本研究确定了接受消融术的患者的室性心动过速复发率，消融术仅限于临床室性心动过速沿着可标测的室性心动过速方法将患有缺血性心肌病和血流动力学耐受的VT的受试者随机分为临床消融组（n = 60）和靶向瘢痕中所有“异常”电描记图的基于基质的消融组（n = 58）。主要终点为室性心动过速复发。次要终点包括围手术期并发症、12个月死亡率和再住院率。结果在12个月随访时，基质消融组和临床室性心动过速消融组分别有9例（15.5%）和29例（48.3%）患者室性心动过速复发（对数秩p < 0.001）。接受临床室性心动过速消融术的患者（58%）在消融术后服用抗心律失常药物的比例高于基质消融术（12%; p < 0.001）。7例（12%）基质消融患者和19例（32%）临床消融患者需要再次住院（p = 0.014）。总体12个月死亡率为11.9%;基质消融组为8.6%，临床消融组为15.0%（对数秩p = 0.21）。基质消融术的再住院率和死亡率显著降低（p = 0.003）。两组围手术期并发症相似（p = 0.61）。结论：在缺血性心肌病伴耐受性室性心动过速患者中，广泛的基于基质的消融方法上级仅针对临床和稳定室性心动过速的消融。（消融临床室性心动过速与增加基质消融对VT消融长期成功率的影响（VISTA）; NCT 01045668）（C）2015，美国心脏病学会基金会。
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.