Marchlinski, Francis E., Haffajee, Charles I., Beshai, John F., Dickfeld, Timm-Michael L., Gonzalez, Mario D., Hsia, Henry H., Schuger, Claudio D., Beckman, Karen J., Bogun, Frank M., Pollak, Scott J., Bhandari, Anil K.
funding text
This paper was funded by an F. Harlan Batrus Research Grant at the University of Pennsylvania. The study was sponsored by Biosense Webster, Inc., and editorial support was funded by Biosense Webster. Dr. Marchlinski has received consulting fees and/or honorarium from Biosense Webster, St. Jude Medical, Medtronic, Biotronik, Boston Scientific, CardioInsight, and Abbott Laboratories. Dr. Dickfeld has received consulting fees and grant support from Biosense Webster. Dr. Gonzalez has received consulting fees and fellowship support from Biosense Webster. Dr. Hsia has received honorarium from Biosense Webster, Medtronic, and VytronUs. Dr. Bogun has received a research grant from Biosense Webster. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
abstract
BACKGROUND 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) (C) 2016 by the American College of Cardiology Foundation.