BACKGROUND: Catheter ablation using radiofrequency (RF) energy is an established treatment for ventricular tachycardia (VT). Tissue temperature is a key determinant of successful lesion creation, and yet, it is difficult to measure during conventional RF ablation because of the cooling effect of high-flow rate saline irrigation. The TRAC-VT study evaluated the safety and efficacy of a novel irrigated RF ablation system modulating power based on real-time tissue temperature. METHODS: Patients with sustained monomorphic VT and structural heart disease (SHD) were enrolled. Catheter ablation was performed in temperature-control mode (irrigation 8 ml/min, temperature set-points 55 or 60 °C, and power output ≤ 50 W), with RF applications for ≤ 45 s. The primary safety endpoint was a composite of cardiovascular-specific serious procedure-related adverse events within 30 days post-ablation. The primary effectiveness endpoint was acute success (i.e., non-inducibility of all clinically relevant VTs). RESULTS: Thirty-eight patients were enrolled with monomorphic VT (age 68 ± 12 years and 84% male), with an average of 1.7 ± 1.2 VTs targeted per patient. In total, 41 ± 23 RF applications per patient were delivered. Acute procedural success was 100% (95% CI, 91-100%). No primary safety endpoints were observed. Six-month follow-up was completed in 92% of patients with 81% (95% CI, 65-91%) freedom from sustained or treated VT. A repeat ablation was performed in three patients. CONCLUSIONS: Ablation of VT in SHD, using a temperature-controlled irrigated RF catheter, was safe and effective with a low rate of VT recurrence at 6 months.

Cardiologie CHU de Rouen Rouen France

Department of Biomedical Surgical and Dental Sciences University of Milan Milan Italy

Department of Cardiology Hospital Universitario Ramón y Cajal Madrid Spain

Department of Cardiology University Hospitals Coventry and Warwickshire NHS Trust Coventry UK

Dept of Clinic Electrophysiology and Cardiac Pacing Heart Rhythm Center Centro Cardiologico Monzino Milan Italy

Heart Rhythm Research Group Division of Biomedical Sciences Warwick Medical School Clinical Sciences Research Laboratory Coventry UK

Institute for Clinical and Experimental Medicine Prague Czechia

Medtronic Minneapolis USA

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