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

Publication ,  Journal Article
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 ...
Published in: J Cardiovasc Electrophysiol
February 2015

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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Published In

J Cardiovasc Electrophysiol

DOI

EISSN

1540-8167

Publication Date

February 2015

Volume

26

Issue

2

Start / End Page

151 / 157

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time Factors
  • Tachycardia, Ventricular
  • Remission Induction
  • Recurrence
  • Pilot Projects
  • Middle Aged
  • Male
  • Humans
 

Citation

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Al-Khatib, S. M., Daubert, J. P., Anstrom, K. J., Daoud, E. G., Gonzalez, M., Saba, S., … Stevenson, W. G. (2015). Catheter ablation for ventricular tachycardia in patients with an implantable cardioverter defibrillator (CALYPSO) pilot trial. J Cardiovasc Electrophysiol, 26(2), 151–157. https://doi.org/10.1111/jce.12567
Al-Khatib, Sana M., James P. Daubert, Kevin J. Anstrom, Emile G. Daoud, Mario Gonzalez, Samir Saba, Kevin P. Jackson, et al. “Catheter ablation for ventricular tachycardia in patients with an implantable cardioverter defibrillator (CALYPSO) pilot trial.J Cardiovasc Electrophysiol 26, no. 2 (February 2015): 151–57. https://doi.org/10.1111/jce.12567.
Al-Khatib SM, Daubert JP, Anstrom KJ, Daoud EG, Gonzalez M, Saba S, et al. Catheter ablation for ventricular tachycardia in patients with an implantable cardioverter defibrillator (CALYPSO) pilot trial. J Cardiovasc Electrophysiol. 2015 Feb;26(2):151–7.
Al-Khatib, Sana M., et al. “Catheter ablation for ventricular tachycardia in patients with an implantable cardioverter defibrillator (CALYPSO) pilot trial.J Cardiovasc Electrophysiol, vol. 26, no. 2, Feb. 2015, pp. 151–57. Pubmed, doi:10.1111/jce.12567.
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. Catheter ablation for ventricular tachycardia in patients with an implantable cardioverter defibrillator (CALYPSO) pilot trial. J Cardiovasc Electrophysiol. 2015 Feb;26(2):151–157.
Journal cover image

Published In

J Cardiovasc Electrophysiol

DOI

EISSN

1540-8167

Publication Date

February 2015

Volume

26

Issue

2

Start / End Page

151 / 157

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time Factors
  • Tachycardia, Ventricular
  • Remission Induction
  • Recurrence
  • Pilot Projects
  • Middle Aged
  • Male
  • Humans