Long-term success of irrigated radiofrequency catheter ablation of sustained ventricular tachycardia: Post-approval THERMOCOOL VT trial

Francis E. Marchlinski, Charles I. Haffajee, John F. Beshai, Timm Michael L. Dickfeld, Mario D. Gonzalez, Henry H. Hsia, Claudio D. Schuger, Karen J. Beckman, Frank M. Bogun, Scott J. Pollak, Anil K. Bhandari

Research output: Contribution to journalArticle

51 Scopus citations

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)

Original languageEnglish (US)
Pages (from-to)674-683
Number of pages10
JournalJournal of the American College of Cardiology
Volume67
Issue number6
DOIs
StatePublished - Feb 16 2016

    Fingerprint

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Marchlinski, F. E., Haffajee, C. I., Beshai, J. F., Dickfeld, T. M. L., Gonzalez, M. D., Hsia, H. H., Schuger, C. D., Beckman, K. J., Bogun, F. M., Pollak, S. J., & Bhandari, A. K. (2016). Long-term success of irrigated radiofrequency catheter ablation of sustained ventricular tachycardia: Post-approval THERMOCOOL VT trial. Journal of the American College of Cardiology, 67(6), 674-683. https://doi.org/10.1016/j.jacc.2015.11.041