Kautzner Josef, Moreno Javier, Tondo Claudio, Anselme Frédéric, Burrell James, Becker Daniel, Peichl Petr, Patchett Ian, Dhanjal Tarvinder
Institute for Clinical and Experimental Medicine, Prague, Czechia.
Department of Cardiology, Hospital Universitario Ramón y Cajal, Madrid, Spain.
J Interv Card Electrophysiol. 2025 Feb 1. doi: 10.1007/s10840-025-01995-z.
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.
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).
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.
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.
使用射频（RF）能量进行导管消融是治疗室性心动过速（VT）的既定方法。组织温度是成功形成损伤的关键决定因素，然而，在传统的射频消融过程中，由于高流量盐水冲洗的冷却作用，很难进行测量。TRAC-VT研究评估了一种基于实时组织温度调节功率的新型灌注射频消融系统的安全性和有效性。
纳入患有持续性单形性室性心动过速和结构性心脏病（SHD）的患者。在温度控制模式下进行导管消融（冲洗速度8 ml/min，温度设定点55或60°C，功率输出≤50 W），射频应用时间≤45秒。主要安全终点是消融后30天内与心血管相关的严重手术相关不良事件的综合指标。主要有效性终点是急性成功（即所有临床相关室性心动过速均不能诱发）。
38例持续性单形性室性心动过速患者入组（年龄68±12岁，男性占84%），平均每位患者有1.7±1.2个目标室性心动过速。每位患者总共进行了41±23次射频应用。急性手术成功率为100%（95%CI，91-100%）。未观察到主要安全终点。92%的患者完成了6个月的随访，其中81%（95%CI，65-91%）无持续性或经治疗的室性心动过速。3例患者进行了再次消融。
使用温度控制的灌注射频导管对结构性心脏病患者的室性心动过速进行消融是安全有效的，6个月时室性心动过速复发率较低。
