Authors
Korolev S.V. 1, Artyukhina E.A.2, Shabanov V.V.3, Sapelnikov O.V.4, Revishvili A.S.2, Romanov A.В.3
1 Сardiac Surgery Department of Federal Research and Clinical Center, Moscow
2 National medical state center of surgery named after A.V. Vishnevsky, Moscow
3 Meshalkin National Medical Research Center, Novosibirsk
4 National Medical Research Center for Cardiology, Moscow
Abstract
The results of ventricular tachycardia (VT) ablation in patients with structural heart disease are not optimal. Our previous study demonstrated that the use of high-energy radiofrequency ablation (RFA) in ischemic patients has a good long-term beneficial effect. This study is a randomized comparison of the efficacy of high power RFA with standard RFA power characteristics.
Aim: is to compare the results of treatment of ventricular tachycardias in ischemic patients with high power RFCA (50 W) and standard RFCA (45 W) in a multicenter prospective registry.
Methods: The study included 119 patients (59% men) with ischemic heart disease and drug-resistant VT who were referred for RFA. The patients were randomly divided into two groups. In the first group, the ablation procedure was performed with 50 W RF energy (high power RFA), in the second group, with 45 W (standard RFA). Non-fluoroscopic 3D navigation systems were used for bipolar and activation mapping with standard settings. The safety endpoint included perioperative complications such as death, hemopericardium, stroke, myocardial infarction, electrical storm, and vascular complications. The efficacy endpoint is VT inducibility at the end of the ablation procedure and no VT at 12 months of follow-up. Primary secondary endpoints: change in implanted cardiovector-defibrillator (ICD) therapy, ultrasound scores, and number of hospitalizations.
Results. All patients underwent VT ablation under general sedation. Before the ablation procedure, at least 1 clinical VT was induced in 96,8% of patients in the high-power RFA group and 92,9% in patients in the standard RFA group. After ablation, clinical VT was not induced (p<0,0001 compared to pre-ablation data) in both groups. None of the patients experienced perioperative complications. The absence of VT without antiarrhythmic drugs was 82,6% after 12 months of observation in the high-power RFA group and 76,2%. In the high-power RFA group, there was a significant decrease in the frequency of EMS calls during the observation period compared with the standard RFA group (high-power RFA — 0,82 (0,99), standard RFA — 0,86 (1.29)) (p = 0,004). After 12 months, there were no statistically significant differences between the groups. There was a statistically significant reduction in hospital admissions (from 2 [range: 0–12] to 0 [range: 0–3], before and after ablation, respectively, p<0,0001). A statistically significantly higher frequency and severity of heart failure (HF) was found in patients from the high power RFA group (p<0.0001) before the procedure, NYHA class III and IV prevailed. In both groups, there was a statistically significant change in the severity of HF, with the most pronounced pattern of decrease in the high-power RFA group.
Conclusion. High-power radiofrequency ablation for the treatment of VT in ischemic patients has demonstrated a safety comparable to the standard approach and a statistically significant higher perioperative and long-term efficacy compared to the ablation procedure with standard power parameters.
Keywords: ventricular tachycardia; chronic heart failure; high power radiofrequency ablation.
References
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