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

Abstract：

: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.

journal_name

Heart Rhythm

journal_title

Heart rhythm

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

doi

10.1016/j.hrthm.2016.04.001

subject

Has Abstract

pub_date

2016-08-01 00:00:00

pages

1748-54

issue

8

eissn

1547-5271

issn

1556-3871

pii

S1547-5271(16)30160-6

journal_volume

13

pub_type

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