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J Am Coll Cardiol, 2000; 35:1905-1914
© 2000 by the American College of Cardiology Foundation
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CLINICAL STUDIES

Catheter ablation of ventricular tachycardia in patients with structural heart disease using cooled radiofrequency energy

Results of a prospective multicenter study

Hugh Calkins, MD, FACCa, Andrew Epstein, MD, FACCa, Douglas Packer, MD, FACCa, Amelia M. Arria, PhDa, John Hummel, MD, FACCa, David M. Gilligan, MD, FACCa, Janet Trusso, RNa, Mark Carlson, MD, FACCa, Richard Luceri, MD, FACCa, Harry Kopelman, MD, FACCa, David Wilber, MD, FACCa, J. Marcus Wharton, MD, FACCa, William Stevenson, MD, FACCa for the Cooled RF Multi Center Investigators Group*

a Johns Hopkins University Schools of Medicine and Public Health, Baltimore, Maryland, USA

Manuscript received April 28, 1999; revised manuscript received December 10, 1999, accepted February 3, 2000.

Reprint requests and correspondence: Dr. Hugh Calkins, The Johns Hopkins University School of Medicine, Carnegie 592, 600 N. Wolfe Street, Baltimore, Maryland 21287
hcalkins{at}jhmi.edu

OBJECTIVES

The purpose of this multicenter study was to evaluate the safety and efficacy of a radiofrequency (RF) catheter ablation system with internal saline irrigation.

BACKGROUND

Catheter ablation of ventricular tachycardia (VT) associated with structural heart disease is more difficult than ablation of idiopathic VT. The larger size of responsible reentrant circuits contributes to the difficulty in achieving an adequate ablation lesion with conventional techniques. Recently, cooling of the ablation electrode by saline irrigation has been shown to increase RF lesion size.

METHODS

The patient population included 146 patients who participated in the Cooled RF Ablation System clinical trial and underwent an attempt at ablation of VT occurring in the presence of structural heart disease. The duration of follow-up was 243 ± 153 days.

RESULTS

Catheter ablation was acutely successful, as defined by elimination of all mappable VTs, in 106 patients (75%). In 59 patients (41%), no VT of any type was inducible after ablation. Twelve patients (8%) experienced a major complication. After catheter ablation, 66 patients (46%) developed one or more episodes of a sustained ventricular arrhythmia.

CONCLUSIONS

The results of this study demonstrate that catheter ablation of all mappable forms of sustained VT can be performed with high initial success and a moderate incidence of major complications (8%).

Abbreviations and Acronyms
  ECG = electrocardiogram
  EF = ejection fraction
  EP = electrophysiology
  ICD = implantable cardioverter defibrillator
  RF = radiofrequency
  VT = ventricular tachycardia




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