Catheter ablation of ventricular tachycardia: Lessons learned from past clinical trials and implications for future clinical trials.

Published

Journal Article (Review)

Catheter ablation of ventricular tachycardia (VT) has evolved in recent years, especially in patients with ischemic heart disease. Data from prospective studies show that VT catheter ablation reduces the risk of recurrent VT; however, there is a paucity of data on the effect of VT catheter ablation on mortality and patient-centered outcomes such as quality of life. Performing randomized clinical trials of VT catheter ablation can be fraught with challenges, and, as a result, several prior trials of VT catheter ablation had to be stopped prematurely. The main challenges are inability to blind the patient to therapy to obtain a traditional control group, high crossover rates between the 2 arms of the study, patient refusal to participate in trials in which they have an equal chance of receiving a "pill" vs an invasive procedure, heterogeneity of mapping and ablation techniques as well as catheters and equipment, rapid evolution of technology that may make findings of any long trial less relevant to clinical practice, lack of consensus on what constitutes acute procedural and long-term success, and presentation of patients to electrophysiologists late in the course of their disease. In this article, a panel of experts on VT catheter ablation and/or clinical trials of VT catheter ablation review challenges faced in conducting prior trials of VT catheter ablation and offer potential solutions for those challenges. It is hoped that the proposed solutions will enhance the feasibility of randomized clinical trials of VT catheter ablation.

Full Text

Duke Authors

Cited Authors

  • Pokorney, SD; Friedman, DJ; Calkins, H; Callans, DJ; Daoud, EG; Della-Bella, P; Jackson, KP; Shivkumar, K; Saba, S; Sapp, J; Stevenson, WG; Al-Khatib, SM

Published Date

  • August 2016

Published In

Volume / Issue

  • 13 / 8

Start / End Page

  • 1748 - 1754

PubMed ID

  • 27050910

Pubmed Central ID

  • 27050910

Electronic International Standard Serial Number (EISSN)

  • 1556-3871

Digital Object Identifier (DOI)

  • 10.1016/j.hrthm.2016.04.001

Language

  • eng

Conference Location

  • United States