Catheter ablation for ventricular tachycardia in patients with an implantable cardioverter defibrillator (CALYPSO) pilot trial

Sana M. Al-Khatib, James P. Daubert, Kevin J. Anstrom, Emile G. Daoud, Mario Gonzalez, Samir Saba, Kevin P. Jackson, Tammy Reece, Joan Gu, Sean D. Pokorney, Christopher B. Granger, Paul L. Hess, Daniel B. Mark, William G. Stevenson

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Catheter Ablation for Ventricular Tachycardia Introduction We conducted this pilot randomized clinical trial to determine the feasibility of a large clinical trial aimed at testing whether early use of catheter ablation of ventricular tachycardia (VT) is superior to antiarrhythmic medications at reducing mortality. Methods and Results Patients were enrolled at 4 sites if they had ischemic heart disease, an implantable cardioverter defibrillator (ICD), and received ≥1 ICD shock or ≥3 antitachycardia pacing therapies for VT. Patients were randomized to 2 arms: (1) antiarrhythmic medication (n = 14) and (2) catheter ablation (n = 13); patients were followed at 3 and 6 months. Endpoints included recurrent VT, time to first ICD therapy for VT, and death. Of 243 screened patients, 27 were enrolled. Main reasons for screen failures were: (1) patient was already on an antiarrhythmic medication (88 [41%]), (2) VT due to a reversible cause (23 [11%]), and (3) incessant VT (20 [9%]). Fourteen patients had recurrent VT, 8 (62%) in the ablation arm and 6 (43%) in the antiarrhythmic medication arm. Median time to recurrent VT was 75 days (25th, 75th: 51, 89) in the ablation arm and 57 days (30, 145) in the antiarrhythmic arm. Four patients died, 2 in each arm. Conclusion This clinical trial shows that most patients in clinical practice have already failed antiarrhythmic drug therapy before catheter ablation is considered, and the VT recurrence rates and death in these patients are high. For a large clinical trial to be feasible, factors limiting early consideration of catheter ablation need to be identified and addressed.

Original languageEnglish (US)
Pages (from-to)151-157
Number of pages7
JournalJournal of Cardiovascular Electrophysiology
Volume26
Issue number2
DOIs
StatePublished - Jan 1 2015

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Catheter Ablation
Implantable Defibrillators
Ventricular Tachycardia
Clinical Trials
Mortality
Anti-Arrhythmia Agents
Myocardial Ischemia
Shock
Randomized Controlled Trials
Recurrence
Drug Therapy

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Al-Khatib, Sana M. ; Daubert, James P. ; Anstrom, Kevin J. ; Daoud, Emile G. ; Gonzalez, Mario ; Saba, Samir ; Jackson, Kevin P. ; Reece, Tammy ; Gu, Joan ; Pokorney, Sean D. ; Granger, Christopher B. ; Hess, Paul L. ; Mark, Daniel B. ; Stevenson, William G. / Catheter ablation for ventricular tachycardia in patients with an implantable cardioverter defibrillator (CALYPSO) pilot trial. In: Journal of Cardiovascular Electrophysiology. 2015 ; Vol. 26, No. 2. pp. 151-157.
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title = "Catheter ablation for ventricular tachycardia in patients with an implantable cardioverter defibrillator (CALYPSO) pilot trial",
abstract = "Catheter Ablation for Ventricular Tachycardia Introduction We conducted this pilot randomized clinical trial to determine the feasibility of a large clinical trial aimed at testing whether early use of catheter ablation of ventricular tachycardia (VT) is superior to antiarrhythmic medications at reducing mortality. Methods and Results Patients were enrolled at 4 sites if they had ischemic heart disease, an implantable cardioverter defibrillator (ICD), and received ≥1 ICD shock or ≥3 antitachycardia pacing therapies for VT. Patients were randomized to 2 arms: (1) antiarrhythmic medication (n = 14) and (2) catheter ablation (n = 13); patients were followed at 3 and 6 months. Endpoints included recurrent VT, time to first ICD therapy for VT, and death. Of 243 screened patients, 27 were enrolled. Main reasons for screen failures were: (1) patient was already on an antiarrhythmic medication (88 [41{\%}]), (2) VT due to a reversible cause (23 [11{\%}]), and (3) incessant VT (20 [9{\%}]). Fourteen patients had recurrent VT, 8 (62{\%}) in the ablation arm and 6 (43{\%}) in the antiarrhythmic medication arm. Median time to recurrent VT was 75 days (25th, 75th: 51, 89) in the ablation arm and 57 days (30, 145) in the antiarrhythmic arm. Four patients died, 2 in each arm. Conclusion This clinical trial shows that most patients in clinical practice have already failed antiarrhythmic drug therapy before catheter ablation is considered, and the VT recurrence rates and death in these patients are high. For a large clinical trial to be feasible, factors limiting early consideration of catheter ablation need to be identified and addressed.",
author = "Al-Khatib, {Sana M.} and Daubert, {James P.} and Anstrom, {Kevin J.} and Daoud, {Emile G.} and Mario Gonzalez and Samir Saba and Jackson, {Kevin P.} and Tammy Reece and Joan Gu and Pokorney, {Sean D.} and Granger, {Christopher B.} and Hess, {Paul L.} and Mark, {Daniel B.} and Stevenson, {William G.}",
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Al-Khatib, SM, Daubert, JP, Anstrom, KJ, Daoud, EG, Gonzalez, M, Saba, S, Jackson, KP, Reece, T, Gu, J, Pokorney, SD, Granger, CB, Hess, PL, Mark, DB & Stevenson, WG 2015, 'Catheter ablation for ventricular tachycardia in patients with an implantable cardioverter defibrillator (CALYPSO) pilot trial', Journal of Cardiovascular Electrophysiology, vol. 26, no. 2, pp. 151-157. https://doi.org/10.1111/jce.12567

Catheter ablation for ventricular tachycardia in patients with an implantable cardioverter defibrillator (CALYPSO) pilot trial. / Al-Khatib, Sana M.; Daubert, James P.; Anstrom, Kevin J.; Daoud, Emile G.; Gonzalez, Mario; Saba, Samir; Jackson, Kevin P.; Reece, Tammy; Gu, Joan; Pokorney, Sean D.; Granger, Christopher B.; Hess, Paul L.; Mark, Daniel B.; Stevenson, William G.

In: Journal of Cardiovascular Electrophysiology, Vol. 26, No. 2, 01.01.2015, p. 151-157.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Catheter ablation for ventricular tachycardia in patients with an implantable cardioverter defibrillator (CALYPSO) pilot trial

AU - Al-Khatib, Sana M.

AU - Daubert, James P.

AU - Anstrom, Kevin J.

AU - Daoud, Emile G.

AU - Gonzalez, Mario

AU - Saba, Samir

AU - Jackson, Kevin P.

AU - Reece, Tammy

AU - Gu, Joan

AU - Pokorney, Sean D.

AU - Granger, Christopher B.

AU - Hess, Paul L.

AU - Mark, Daniel B.

AU - Stevenson, William G.

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Catheter Ablation for Ventricular Tachycardia Introduction We conducted this pilot randomized clinical trial to determine the feasibility of a large clinical trial aimed at testing whether early use of catheter ablation of ventricular tachycardia (VT) is superior to antiarrhythmic medications at reducing mortality. Methods and Results Patients were enrolled at 4 sites if they had ischemic heart disease, an implantable cardioverter defibrillator (ICD), and received ≥1 ICD shock or ≥3 antitachycardia pacing therapies for VT. Patients were randomized to 2 arms: (1) antiarrhythmic medication (n = 14) and (2) catheter ablation (n = 13); patients were followed at 3 and 6 months. Endpoints included recurrent VT, time to first ICD therapy for VT, and death. Of 243 screened patients, 27 were enrolled. Main reasons for screen failures were: (1) patient was already on an antiarrhythmic medication (88 [41%]), (2) VT due to a reversible cause (23 [11%]), and (3) incessant VT (20 [9%]). Fourteen patients had recurrent VT, 8 (62%) in the ablation arm and 6 (43%) in the antiarrhythmic medication arm. Median time to recurrent VT was 75 days (25th, 75th: 51, 89) in the ablation arm and 57 days (30, 145) in the antiarrhythmic arm. Four patients died, 2 in each arm. Conclusion This clinical trial shows that most patients in clinical practice have already failed antiarrhythmic drug therapy before catheter ablation is considered, and the VT recurrence rates and death in these patients are high. For a large clinical trial to be feasible, factors limiting early consideration of catheter ablation need to be identified and addressed.

AB - Catheter Ablation for Ventricular Tachycardia Introduction We conducted this pilot randomized clinical trial to determine the feasibility of a large clinical trial aimed at testing whether early use of catheter ablation of ventricular tachycardia (VT) is superior to antiarrhythmic medications at reducing mortality. Methods and Results Patients were enrolled at 4 sites if they had ischemic heart disease, an implantable cardioverter defibrillator (ICD), and received ≥1 ICD shock or ≥3 antitachycardia pacing therapies for VT. Patients were randomized to 2 arms: (1) antiarrhythmic medication (n = 14) and (2) catheter ablation (n = 13); patients were followed at 3 and 6 months. Endpoints included recurrent VT, time to first ICD therapy for VT, and death. Of 243 screened patients, 27 were enrolled. Main reasons for screen failures were: (1) patient was already on an antiarrhythmic medication (88 [41%]), (2) VT due to a reversible cause (23 [11%]), and (3) incessant VT (20 [9%]). Fourteen patients had recurrent VT, 8 (62%) in the ablation arm and 6 (43%) in the antiarrhythmic medication arm. Median time to recurrent VT was 75 days (25th, 75th: 51, 89) in the ablation arm and 57 days (30, 145) in the antiarrhythmic arm. Four patients died, 2 in each arm. Conclusion This clinical trial shows that most patients in clinical practice have already failed antiarrhythmic drug therapy before catheter ablation is considered, and the VT recurrence rates and death in these patients are high. For a large clinical trial to be feasible, factors limiting early consideration of catheter ablation need to be identified and addressed.

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