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 journalArticlepeer-review

76 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
Externally publishedYes

Keywords

  • catheter ablation
  • quality of life
  • radiofrequency
  • safety
  • ThermoCool
  • ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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