Letter from the Editor in Chief

DOI: 10.19102/icrm.2015.060901

MOUSSA MANSOUR, MD, FHRS, FACC

Editor-in-Chief

Dear Readers,

This issue of the Journal contains many interesting publications. I would like to highlight the review article entitled “Catheter Ablation of Ventricular Tachycardia as an Adjunct Therapy to Reduce ICD Shocks” by Hoskins et al. The authors provide a detailed evaluation of numerous ICD clinical trials that demonstrated the detrimental effects of ICD shocks. These include increased risk of death, increased anxiety and decreased quality of life, and increased use of health care resources. The authors also evaluated the anti-arrhythmic drug trials showing a marginal effect of medications on controlling ventricular tachycardia (VT), and concluded by elegantly discussing the beneficial role of VT ablation.

Ablation for VT has been performed for many years. However the interest in this procedure and the volume of VT ablations remained low for a long time. Possible reasons for the low adoption include the lack of robust data demonstrating a beneficial effect of VT ablation, and the challenging nature of this procedure which requires a high level of skill. That trend started to change after two landmark clinical trials, SMASH-VT and VTACH, which demonstrated that prophylactic catheter ablation can reduce ICD therapy in patients with a history of VT. While extremely important, these two trials had limitations: 1-they were small and thus did not have the power to evaluate the effect of VT ablation on many clinical and economical outcomes, and 2-were limited to patients with ischemic cardiomyopathy.

One important study aiming to address these limitations is the “Substrate targeted ablation using the FlexAbility™ Ablation Catheter System for the reduction of Ventricular Tachycardia” (STAR-VT). This study, which recently started patient enrollment, has the objective of demonstrating that scar-based VT ablation, in subjects who are indicated for new ICD and are at high risk of ICD shock, results in a superior clinical outcome compared to routine drug therapy. This multicenter study will enroll over 1,400 patients with ischemic and non-ischemic cardiomyopathy. In addition, STAR-VT allows epicardial ablation which is expected to improve the efficacy of the procedure especially in patients with non-ischemic cardiomyopathy. Another highlight of the study is a uniform ablation strategy and ICD programming which are important for meaningful results.

In summary the field of VT ablation appears to be rapidly developing. Large multicenter clinical studies such as STAR-VT are critical for improving our understanding of this arrhythmia.

Best regards and I hope you enjoy reading this issue of the Journal.

Regards,

Editor-in-Chief

Moussa Mansour, MD, FHRS, FACC
Editor-in-Chief
The Journal of Innovations in Cardiac Rhythm Management
MMansour@InnovationsInCRM.com
Director, Cardiac Electrophysiology Laboratory
Director, Atrial Fibrillation Program
Massachusetts General Hospital
Boston, MA