Computed tomography-guided vs conventional catheter ablation for ventricular tachycardia: the InEurHeart trial.

Abstract (English)

BACKGROUND AND AIMS: Catheter ablation is performed in patients with recurrent ventricular tachycardia (VT) but remains complex and limited to experienced centres. Ventricular tachycardia ablation guided by pre-procedural imaging was shown promising in non-randomized trials. InEurHeart aims to evaluate computed tomography (CT)-guided VT ablation vs conventional ablation in a multicentre randomized controlled trial. METHODS: In 14 European centres, 113 patients with prior myocardial infarction and clinically significant VT were randomly assigned to CT-guided (n = 57) or conventional (n = 56) VT ablation. The primary objective was to demonstrate reduced procedural duration when using CT guidance. Secondary endpoints included efficacy (incidence and burden of ventricular arrhythmia), safety, as well as composite endpoints. RESULTS: The primary endpoint showed a significant decrease in procedure time favouring CT-guided ablation: 149 &#xb1; 51 to 120 &#xb1; 50 min, -19% [95% confidence interval (CI) -32; -7]; P = .0027 in intention to treat, and 149 &#xb1; 51 to 107 &#xb1; 38 min, -28% (95% CI -40; -16); P < .0001 per protocol. Major adverse events occurred in two (3.5%) in the conventional group vs one (1.8%) in the CT-guided group [-1.8% (95% CI -7.9; 4.3)]. Ventricular tachycardia-free survival at 1 year was achieved in 37 (67.3%) patients for conventional vs 43 (76.8%) for CT-guided VT ablation [9.5% (95% CI -10.4; 29.4), P = NS]. Ventricular tachycardia burden was decreased by 90% in the CT-guided group. CONCLUSIONS: In patients with ischaemic cardiomyopathy, CT-guided VT ablation reduces the procedure duration while maintaining a favourable efficacy and safety profile when compared with VT ablation without image integration.