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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003ESubstrate-based ablation of ventricular tachycardia (VT) in patients with ischemic cardiomyopathy resulted in fewer VT recurrences and less rehospitalization compared with the conventional clinical VT ablation. This article present data from the Ablation of Clinical Ventricular Tachycardia Versus Addition of Substrate Ablation on the Long-term Success Rate of VT Ablation trial [VISTA; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01045668\u0026amp;atom=%2Fspmdc%2F14%2F9%2F14.atom\u0022\u003ENCT01045668\u003C\/a\u003E].\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInflammatory Disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology \u0026amp; Cardiovascular Medicine\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInflammatory Disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003ESubstrate-based ablation of ventricular tachycardia (VT) in patients with ischemic cardiomyopathy resulted in fewer VT recurrences and less rehospitalization compared with the conventional clinical VT ablation. Luigi Di Biase, MD, PhD, Texas Cardiac Arrhythmia Institute, Austin, Texas, USA, and Albert Einstein College of Medicine, Bronx, New York, USA, presented data from the Ablation of Clinical Ventricular Tachycardia Versus Addition of Substrate Ablation on the Long-term Success Rate of VT Ablation trial [VISTA; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01045668\u0026amp;atom=%2Fspmdc%2F14%2F9%2F14.atom\u0022\u003ENCT01045668\u003C\/a\u003E].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EPatients with ischemic cardiomyopathy and stable monomorphic VT may undergo catheter ablation as an option to reduce implantable cardiac defibrillator shocks. However, it is unclear if ablation of the clinical stable VT or more extensive substrate-based ablation is more beneficial. The purpose of the VISTA trial was to determine whether substrate-based ablation improved outcomes compared with the conventional ablation of the stable clinical VTs.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EIn the open-label, randomized, parallel-group multicenter VISTA trial, 128 patients with symptomatic, drug-refractory, hemodynamically stable VTs after coronary artery disease were randomly assigned to undergo clinical stable VT ablation or substrate ablation. Every 3 months, patients were assessed by implantable device interrogations and examination during office visits. Baseline characteristics were similar between both study arms, with the mean age ranging from 65 to 67 years and with most patients being men (93%) with hypertension (72% to 76%) or diabetes (32% to 42%). In addition, the mean left ventricular ejection fraction (LVEF) was 32% to 33%, and 33% to 35% had previously undergone coronary artery bypass graft surgery.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe primary endpoint of the VISTA trial was recurrence of any VTs over the 12-month period following ablation. Recurrence was defined as any arrhythmia that required device-based treatment or any VT event that occurred during clinical evaluation. The secondary end points included periprocedural complications and postprocedural mortality and rehospitalization at 12 months.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EAt 12 months, 51.7% of patients who underwent clinical VT ablation achieved freedom from any recurrent VTs, compared with 84.5% of patients who underwent substrate ablation (log-rank p\u0026lt;0.001; \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). In addition, significantly more patients who underwent clinical VT ablation required rehospitalization (32%) than those patients who underwent substrate ablation (12%; p=0.014). Overall mortality in the VISTA trial was 11.9%, with mortality occurring in 15% of patients who underwent clinical VT ablation and 8% who underwent substrate ablation (p=0.21).\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/9\/14\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022VT Recurrence-Free Survival After Ablation\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-310319227\u0022 data-figure-caption=\u0022VT Recurrence-Free Survival After Ablation\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/9\/14\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/9\/14\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/9\/14\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15882\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003EVT Recurrence-Free Survival After Ablation\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EVT=ventricular tachycardia.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced with permission from L Di Biase, MD, PhD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-8\u0022\u003EIn addition, use of the clinical VT ablation method was associated with a greater rate of VT recurrence, with a hazard ratio of 3.84 (p=0.001). Interestingly, other risk factors that were associated with VT recurrence were diabetes (HR, 3.11; p=0.02), LVEF (HR, 0.77; p=0.035), electrical storm (HR, 1.86; p=0.043), male sex (HR, 3.23; p=0.029), and age per 5-year increase (HR, 1.11; p=0.016). Clinical VT ablation (HR, 3.1; p=0.01) and diabetes (HR, 2.75; p=0.042) remained independent predictors of VT recurrence after adjustment for covariates based on a Cox multivariate model.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EComplications of ablation included 1 atrial valve fistula in the clinical VT ablation group and 5 pericardial effusions (2 in the clinical VT ablation group and 3 in the substrate ablation group).\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EDr. Di Biase stated that, in his opinion, the data from the randomized VISTA trial indicate that substrate-based ablation may be superior to clinical VT ablation in patients with ischemic cardiomyopathy with stable VT. However, he noted that additional studies are needed to confirm the results of the VISTA trial.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/9\/14.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzp6g1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzp6g1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}